Advances in Understanding the Use of Yoga as Therapy in Lymphedema

Lymphedema may be caused by dysfunction of the lymphatic system due to damage, block, hypoplasia due to genetic causes or by lymph overload. Lymphatic Filariasis is most prevalent and among the leading causes of disability. This chapter describes the improvements in three yoga protocols of integrative treatment, for lower limb, upper limb, and genital lymphedema. There are two sessions of yoga in our treatment protocol. Yoga helps to drain lymph through various mechanisms. Asanas focus on the dermal stretch, joint movement, muscle pumps, and muscle stretch and pranayamas on lung expansion. Joint movements and muscle contractions are designed to mimic nodal drainage. The yoga protocol also provides knee strengthening, gait correction, shoulder joint strengthening. Yoga asanas for comorbidities like hypertension, cardiovascular diseases, and arthritis and joint surgeries with movement restrictions are customized in the revised protocol. Yoga is an effective treatment in lymphedema and considerably improves the patient's quality of life.

MULTIPLE LYMPHATIC-VENOUS ANASTOMOSES (MLVA) FOR MICROSURGICAL DRAINAGE OF PRIMARY PENO-SCROTAL LYMPHEDEMA: A CASE REPORT

Single site Multiple Lymphatic-Venous Anastomoses (MLVA) provides optimal functional and cosmetic results with low complication rates in treatment of lower limb lymphedema. However, no evidence exists in literature concerning the use of this technique in treatment of peno-scrotal lymphedema. We report a case of a 44-year-old male patient who developed secondary peno-scrotal lymphedema with severe lymphorrhea, following a laser treatment for scrotal pustolosis, leading to recurrent infections and finally an established peno-scrotal lymphedema. Utilizing MLVA, a complete remission of scrotal lymphedema was achieved with significant volume reduction of the penile lymphedema. The post-operative course was uneventful with clear improvement in lymphatic flow demonstrable on lymphoscintigraphy (6 months) and no recurrence of scrotal lymphedema at 2 years follow-up. This article reports very promising results of a novel application of MLVA in the treatment of genital lymphedema and suggests that MLVA provides the possibility to shunt both superficial and deep lymphatics to improve the lymphatic drainage from the peno-scrotal area using a single surgical site.

Surgical Management of Pediatric Lymphedema: A Systematic Review

Background Lymphedema is a rare, progressive, and debilitating condition caused by failure of the lymphatic system to adequately drain the protein-rich fluid exiting the capillaries. Conservative management is often emphasized in pediatric patients, resulting in a paucity of literature describing surgical treatment in this population. Methods A systematic review was performed using PubMed, ScienceDirect, and Google Scholar to identify all studies describing surgical management of lymphedema in the pediatric population. Results Of the 343 relevant articles identified, 14 met the criteria for full review. Articles were divided into the following treatment categories: genital lymphedema, excisional procedures for extremity lymphedema, and physiologic procedures for extremity lymphedema. Outcomes for genital lymphedema were overall positive. For extremity lymphedema, excisional procedures yielded good results overall and included the majority of patients in this study. Physiologic procedures had mixed outcomes in the small population included in this study, but definitive conclusions cannot be drawn due to the paucity of existing data. Conclusion While conservative management of pediatric lymphedema is well described, the literature remains sparse regarding surgical treatment. Further studies are needed to evaluate efficacy and outcomes in all three categories in this population.