Chapter: Conservative therapy
Article: 5 of 8
Update: Mai 15, 2021
Author(s): Wohlgemuth, Walter A.
Manual lymphatic drainage (MLD), which is performed by specially trained medical professionals (often physiotherapists), aims to stimulate physiological lymphatic drainage and its collaterals to reduce the tissue pressure in the affected region through special massage techniques. A prerequisite for this is the presence of mobilizable, pathological edema on the body surface (effectiveness decreases with tissue depth). In principle, it is more commonly used in patients with lymphatic malformations or combined venolymphatic malformations, as a support to compression therapy in order to reduce the extracellular edema in the tissue. Pure phlebedema is usually less progressive or can be treated causally by invasive therapy.
The effectiveness is higher in early forms of edema because later it is no longer possible to exert a relevant influence on the accompanying solid tissue changes and they are irreversible.
In practice, manual lymphatic drainage usually begins on the contralateral, unaffected side to allow decongestion and removal of as much tissue fluid as possible from the extracellular space. The pathological area then drains into the area thus decongested. The edema fluid from the affected extremity is then carefully transferred to the previously drained quadrant by massaging movements.
The problem with manual lymphatic drainage, despite its proven effectiveness, lies in the relatively time-consuming and expensive external application by specialist therapists. Unfortunately, problems with prescribing often occur in the long term, even though this therapy is undoubtedly effective in the long run and reduces the development of irreversible tissue hardening. In the long term, the initially higher investment in an automatic compression device may be discussed, but this does not absolve the patient from regular specialist medical checks of their condition.