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Infection and Other Complications

cellulitis

Lymph fluid is rich in protein called albumin, a type of protein which is trapped or “stuck” without a drainage pathway in patients with lymphedema. This thick, clear, viscous (sticky) fluid is a favorable environment for the growth of bacteria. In addition, lymph nodes (which help fight infections) are compromised or missing in most patients with lymphedema. As a result, infections can progress rapidly and can be severe by the time they are detected. If you experience frequent infections, you may want to discuss the option of prophylactic antibiotics with your physician. 

Signs and symptoms of infection may differ from person to person but generally include pain, redness, rash and/or red blotchy skin, itching of the affected area, increase of swelling, increased temperature of the skin, heavy sensation in the limb (more than usual), flu-like symptoms, and in many cases a sudden onset of high fever and chills. If these symptoms occur in the area of lymphedema, contact your physician immediately. If the office is closed, call the exchange, or go to the closest emergency room. Immediately discontinue ALL current lymphedema treatment modalities (including manual lymphatic drainage, bandaging, and compression garments). The antibiotics of choice for these types of infections are broad-spectrum such as those in the penicillin family (if not allergic). Patients with recurrent infections may need to carry antibiotics or a prescription when traveling.

(Two detailed article reprints on infection are available through the NLN®: 800-541-3259).
Ref. Lymphlink Vol 23, No3 July-Sept 2011

In patients with long-standing untreated lymphedema, infections are the most common complications, but in rare situations a form of lymphatic cancer called lymphangiosarcoma may develop. Symptoms include a purplish discoloration and visible nodules in the affected limb that can progress into a non-healing wound. Contact your doctor if these symptoms occur. Important: Do not ignore your lymphedema in order to prevent further complications. It is never too late to undergo treatment for lymphedema and improve your overall health. 

Other Complications of Lymphedema

  1. The sudden onset of swelling anywhere in the body warrants medical attention and, in a patient with prior cancer, recurrent or ongoing disease must be ruled out. Active tumor growth can block lymphatic flow, causing a worsening of lymphedema or other forms of swelling.
  2. Patients with a sudden onset of swelling/redness/pain (lymphangitis) or evidence of skin infection (cellulitis) in the affected limb should immediately discontinue treatment until the infection subsides.
  3. Patients with histories of venous or arterial disease—especially those who are taking anticoagulants—should have an ultrasound to rule out blood clots (deep-venous thrombosis or DVT) before being treated with CDT. During treatment, patients on anticoagulant therapy (i.e., Warfarin or Coumadin) should be followed closely and regular laboratory tests should be performed according to the recommendations of their physicians. 
  4. Patients with congestive heart failure and lymphedema must be monitored closely to avoid mobilizing too much fluid into the central circulation too quickly, since the heart may not be able to compensate. Any shortness of breath during the first 1-2 days after MLD should prompt immediate evaluation by a physician.
  5. If pain is present, discontinue all treatment until the pain subsides or the underlying cause has been determined.

SPECIAL WARNINGS

After a mastectomy: A heavy breast prosthesis used after a mastectomy may put too much pressure on the lymph nodes above the collar bone. This pressure risks slowing and interrupting the remaining healthy lymphatic pathways. Ideally, a wireless well-fitted bra or vest with wide, padded shoulder straps can lessen the fluid trapping effect. If the prosthesis is large, request that it be lightweight. Patients who experience lymphedema in the chest or truncal area should be fitted with a well fitted compression bra or vest. For information on where to get these items, contact NLN for referral or consult your local non-profit (American Cancer Society, Reach to Recovery,) or your local breast prosthesis distributor.

After an insect bite, burn, or other minor injury: If you are bitten/stung by an insect, or sustain a minor injury (such as a cut or a burn) on the affected extremity, clean the skin thoroughly and utilize a triple antibiotic ointment to prevent the open area from becoming infected. Seek medical attention immediately if signs of redness, swelling, warmth, or pain occur. Treatment with antibiotics is vitally important to prevent a serious infection, hospitalization, and/or the worsening of existing lymphedema.