Complex physical decongestive therapy

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The complex decongestive physical (KPE) is a comprehensive therapy for the treatment of lymphedema , which consists of four components.

Methods

Manual lymph drainage

The manual lymphatic drainage is a specially developed type of massage to the transport capacity of the lymphatic system to increase and thus the removal of edema permit.

Compression therapy

Padding of the arm before applying the compression bandages

Bandaging (self-bandaging or bandaging by a therapist trained in complex physical decongestion therapy).

A compression bandage consists of:

  • Cotton tubular bandage (for skin protection)
  • Wadding or foam for padding (against pressure pain, for better distribution of pressure)
  • Short stretch bandages
  • possibly a long-stretch bandage to fix the short-stretch bandages (to prevent them from slipping)
  • an elastic gauze bandage 4 cm wide (or simply folded 6 cm wide) to bandage the toes or fingers

In contrast to treatment with a compression stocking , the bandaging can also be left overnight if this is necessary for therapeutic reasons, depending on the patient's cooperation and the extent of the lymphedema.

When using a compression stocking, it is essential to ensure that the compression pressure is weaker when viewed from the hand or foot ( distal ) towards the heart ( proximal ) (even if the feet are less affected by the lymphedema), otherwise it becomes even stronger Expressing the lymphedema at the extremity end.

Wearing medical compression stockings made to measure also reduces swelling and, above all, prevents the edema from increasing again.

Movement exercises

Targeted gymnastics also lead to an increase in lymph transport and thus to a decrease in the edema.

Swimming (the higher pressure of the water compared to the air helps with lymphedema), walking, cross-country skiing or Nordic walking are suitable sports.

Skin care

A daily assessment of the skin and, if necessary, appropriate skin care is an important protection against infections . A frequent complication of lymphedema is erysipelas , a streptococcal infection.

Alternatives

There are currently no alternatives to complex physical decongestive therapy.

  • The use of so-called dehydrating agents ( diuretics ) is usually contraindicated because although they remove water for a short time, they harden the tissue in the long term, as they leave the protein in the tissue (also a component of lymphedema).

In addition, the protein left behind has a hydrophilic effect ("water-loving" or water-attracting) and, in the long term, even leads to increased water retention

  • Attempts with autologous transplantation of lymphatic vessels are still in their infancy
  • Likewise, the attempts to reproduce the lymphatic vessels through genetic engineering are in their infancy after setbacks
  • Even in the field of drug therapy, there is still insufficient convincing experience
  • Surgical methods are popular in some places in the USA, but have sometimes led to terrible mutilations and massive deterioration
  • The Intermittent pneumatic compression therapy - also called "Instrumental intermittent compression therapy" (AIK) called - with mechanical pumps is not a substitute for complex physical decongestive therapy, but rather a complement. The IPK should be used with prior and subsequent opening of the lymphatic channels through manual lymphatic drainage. Side effects are rare.

Web links

Individual evidence

  1. ↑ Kerstin Protz, Joachim Dissemond, Knut Kröger: Compression therapy. An overview for the practice. Springer, Berlin 2016, ISBN 978-3-662-49743-2 , page 95
  2. ↑ Guideline IPK , website of the German Society for Phlebology