Content area
Full text
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Lymphedema is a clinical condition resulting from the accumulation of macromolecules in the interstitial space with a consequent buildup of fluids [1, 2]. This condition can have primary or secondary causes. Patients suffering from primary lymphedema are born with some type of alteration of the lymphatic system and secondary cases are the result of damage to the lymphatic system during the lives of patients.
Diagnosis is usually based on a medical history and physical examination; however, in some cases, complementary examinations are required. A volumetric evaluation is necessary to quantify the edema and to evaluate whether the difference in limb size can be considered clinically significant [3]. In relation to the volume evolution, mild lymphedema is defined as a difference of volume <20% in relation to the contralateral limb, moderate with differences between 20 and 40% and above 40% considered severe. In relation to the clinical evolution, stage I is when the edema appears during the day and disappears at night, stage II is when the edema is constant without disappearing even after resting for one week, and stage III is when the limb has large deformities [2].
An association of therapeutic techniques, usually including manual or mechanical lymph drainage, compression therapy, and exercises, is recommended with the main aim being to improve the quality of life of patients [2, 4]. In recent years, a new concept of lymphatic drainage, Cervical Lymphatic Therapy (cervical stimulation), has been developed, which, as believed, stimulates the nervous system leading to drainage of the lymph [5]. An apparatus (RAGodoy) has also been developed that performs Mechanical Lymphatic Drainage [6]. Another contribution is the development of a stocking made of grosgrain fabric that can be used for upper and lower limbs. Grosgrain is inelastic but generates a significant resting pressure [7]. An intensive form of outpatient therapy (6–8 hours/day) has been proposed that can reduce about 50% of the lymphedema volume within five days [2]. However, a difference in response to treatment has been observed between primary and secondary lymphedema. The objective of this study was to compare...