Table of Contents

1 ANATOMY
1.1 Circulatory System
Components
Systemic
Circulation
1.2 Lymphatic System
Embryology and Development of the
Lymphatic System
1.3 Topography
1.4 Components
Lymph Fluid
Lymphatic
Loads
Lymphatic Vessels
Lymphatic Tissues
1.5 Lymphatic
Watersheds
Sagittal Watershed
Horizontal Watershed
Watersheds between
the Trunk and the Extremities
1.6 Interterritorial Anastomoses
1.7
Lymphatic Drainage and Regional Lymph Node Groups of Different Body
Parts
Lymphatic Drainage of the Scalp, Face, and Neck
Lymphatic Drainage
of the Neck
Lymphatic Drainage of the Trunk
Lymphatic Drainage of the
Upper Extremity
Lymphatic Drainage of the Lower Extremity
Recommended
Reading

2 PHYSIOLOGY
2.1 Heart and Circulation
2.2 Blood Pressure
Blood
Capillary Pressure
2.3 Capillary Exchange
Diffusion
Osmosis and Osmotic
Pressure
Colloid Osmosis and Colloid Osmotic Pressure
Filtration and
Reabsorption
2.4 Physiology of the Lymphatic System
Lymph Time Volume and
Transport Capacity of the Lymphatic System
Safety Factor of the Lymphatic
System
2.5 Insufficiencies of the Lymphatic System
Dynamic
Insufficiency
Mechanical Insufficiency
Combined Insufficiency
2.6 Edema
and Lymphedema at a Glance
Edema
Lymphedema
2.7 Understanding Starlings
Equilibrium
Recommended Reading

3 PATHOLOGY
3.1 Lymphedema
Definition
Incidence of
Lymphedema
Lymphedema Incidence among Non-Breast Cancer
Patients
Lymphedema Genetics
Etiology of Lymphedema
Stages of
Lymphedema
Grading of Lymphedema Based on Severity
Precipitating Factors
for Lymphedema
Avoidance Mechanisms
Complications in
Lymphedema
Axillary Web Syndrome
Impact of Lymphedema on Quality of
Life
Diagnosis of Lymphedema
3.2 Evaluation of Lymphedema
Research in
Lymphedema: Issues of Measurement and Assessment of Occurrence

Radiation-Induced Brachial Plexopathy and Lymphedema
Imaging of the
Lymphatic System
Therapeutic Approach to Lymphedema
3.3 Chronic Venous and
Lymphovenous Insufficiency
Definition of CVI
Post-thrombotic
Syndrome
Venous Dynamics in the Lower Extremities
Pathophysiology of
CVI
Stages of CVI
Complications
Evaluation
Therapeutic
Approach
3.4 Wounds and Skin Lesions
Common Skin Changes and Wound Types
Associated with Chronic Lymphedema
Wound Bed Preparation
3.5
Lipedema
Definition
Etiology and Natural History
Pathology and
Pathophysiology of Lipedema
Stages
Evaluation
Therapeutic
Approach
Invasive Modalities
3.6 Traumatic
Edema
Definition
Pathophysiology
Effects of Inflammation on the
Lymphatic System
Therapeutic Approach
3.7 Inflammatory
Rheumatism
Definition
Anatomy of a Synovial
Joint
Pathophysiology
Effects on the Lymphatic System
Therapeutic
Approach
3.8 Reflex Sympathetic Dystrophy
Definition
Pathology and
Stages
Lymphatic Involvement
Therapeutic Approach
3.9 Cyclic Idiopathic
Edema
Complete Decongestive Therapy
References
Recommended Reading

4 COMPLETE DECONGESTIVE THERAPY
4.1 History and Background
Discovery of
the Lymphatic System
Development of Complete Decongestive Therapy
4.2 Goal
of Complete Decongestive Therapy
4.3 Components of Complete Decongestive
Therapy
Manual Lymph Drainage
4.4 Compression Therapy
Effects of
Compression Therapy
Laplace’s Law
Compression Bandages
Compression
Garments
4.5 Exercises and Lymphedema
Breathing Exercises
Resistive
Exercises
Aerobic Exercises for Lymphedema
4.6 Skin and Nail Care
4.7
The Two-Phase Approach in Lymphedema Management
Intensive
Phase
Self-Management Phase
4.8 Documentation Techniques for
Lymphedema
4.9 CDT for Cancer
Survivors
Introduction
Surgery
Radiation Therapy
Breast
Radiation
Chemotherapy
Targeted Therapy
Guidelines for Safe CDT
Intervention
Summary
References
Recommended Reading

5 TREATMENT
5.1 General Considerations
5.2 Application of Basic MLD
Techniques on Different Parts of the Body
Lateral Neck and Submandibular
Area
Abbreviated Neck Sequence
Posterior Neck and Occipital
Area
Face
Posterior Thorax
Lumbar Area
Anterior Thorax
Abdomen
(Superficial and Deep Manipulations)
Upper Extremity
Lower
Extremity
5.3 Treatment Sequences
Truncal Lymphedema
Unilateral
Secondary Upper Extremity Lymphedema
Bilateral Secondary Upper Extremity
Lymphedema
Unilateral Secondary Lower Extremity Lymphedema
Bilateral
Secondary Lower Extremity Lymphedema
Unilateral Primary Lower Extremity
Lymphedema
Bilateral Primary Lower Extremity Lymphedema
Genital
Lymphedema
Phlebolymphostatic Edema
Lipolymphedema
Head and Neck
Lymphedema
Pediatric Lymphedema
5.4 Elastic Taping for
Lymphedema
General Information
Indications and
Contraindications
Preparation and Materials
Application
Patient
Education for Elastic Taping
Removal
5.5 Treatment Strategies for Common
Complications of Lymphedema
Surgical Scars
Debulking
Scars
Hyperkeratosis
Abnormal Folds
Odors and Odor Control
Fungal
infections
Radiation Trauma
PapillomasLymph cysts, varicosities

Collateral veins
Limb paralysis
Self induced lymphedema (Artificial,
Factitious)
Malignant lymphedema
Cellulitis
5.6 CDT Treatment Protocol
Variations: Primary and Secondary Lymphedema
Adaptations for the primary
lymphedema patient
Adaptations for the secondary lymphedema patient
5.7
Adapting CDT to the palliative patient
Set realistic goals
Strengths and
limitations of each CDT modality
CDT management of generalized
edema
Conclusion
5.8 Lipedema Treatment: Understanding the diagnosis and
patient profile
Misguidance and misdiagnosis
Psychological perspective and
Personality attributes
Identifying lipedema and adapting
treatment
Practical guidelines for therapy
Alternative
treatments
Compression garments (see also garment fitting section)
5.9
Application of Compression Bandages
Required Materials
Lymphedema
Bandaging: Selecting Foam Padding
Lymphedema Bandaging: Practical
Guidelines
Upper Extremity Bandaging
Lower Extremity Bandaging
5.10
Bandaging Procedures using Foam Padding
Arm Bandaging Procedure using foam
padding (in detail)
Leg Bandaging Procedure using foam padding (in
detail)
5.11 Genital Lymphedema Treatment
Secondary Genital
Lymphedema
Primary Genital Lymphedema
Predisposition to develop
lymphedema
Complications
Surgical Treatment
Conservative
Therapy
5.12 Truncal Lymphedema
Lymphedema of the Thorax
Lymphedema of
the Abdomen
5.13 Bandaging in Presence of Wounds
Precautions and
Contraindications
Treat the Wound
Apply Compression
Summary
5.14
Measurements for Compression Garments
Measuring for Stockings and
Pantyhose
Measuring for Arm Sleeves
Measuring for Hand and Finger
Compression Garments
Compression Neck and Chin Straps and Face
Masks
Compression Garments for the Upper Thorax and Breast
5.15
Compression Bandaging Alternatives: Guidelines to Choosing the Right Homecare
Systems
Rationale for an Alternative
Important Considerations
Product
Categories
Maximizing the Benefits of Alternative Devices
Patient
Education/Long-term Compression Therapy
Suggested modifications by product
category
5.16 Treatment Considerations in Managing the Morbidly Obese
Patient
The Problem
Equipment
Treatment Challenges
5.17 Patient
Education
Lymphedema Therapists
Self-Bandaging
Decongestive
Exercises
Self-MLD
Precautions
Lymphedema and Air Travel
5.18
Surgical Treatment
Surgical Treatment of Lymphedema
Breast and Axillary
Reconstruction Primer for the Certified Lymphedema
Therapist
References
Recommended Reading

6 ADMINISTRATION
6.1 Setting Up a Lymphedema
Clinic
Personnel
Required Space
Equipment
Marketing Issues
6.2
Suggested Materials to Start Up a Lymphedema Program
6.3 Reimbursements and
Billing
CPT Codes
Recommended Reading

About the Author

Founder and Execuive Director, Norton School of Lymphatic Therapy, Matawan, NJ, US

Reviews

This comprehensive guide with so much good advice will be of much practical value to all who care for lymphedema patients and their difficult problems. --European Journal of Plastic Surgery