Lower limb lymphedema

　　1, Primary lymphedema is caused by abnormal development of lymphatic vessels, most of which are lymphatic hypoplasia, and a few are abnormal hyperplasia and expansion of lymphatic vessels.

　　2, Secondary lymphedema is caused by lymphatic obstruction due to certain diseases. Common filarial infections are now rare, and streptococcal infections and radiotherapy due to cancer and lymph node dissection are the main causes of lymphedema.

　　What are the common complications of lymphedema

　　1, Incision infection, lymph leakage.

　　2, Systemic reaction: fever, nausea, vomiting, and due to allergy to the contrast agent, individual cases may produce peripheral circulatory collapse.

　　3, Local lymphatic reactive inflammation, which makes lymphedema worse.

　　4, Pulmonary embolism: The contrast agent may increase pressure and enter the vein through the anastomotic collateral, causing pulmonary embolism, with an incidence rate of 2-10%, and there are reports in literature of death due to pulmonary embolism.

　　The main manifestation is swelling of one limb, starting from the ankle and foot, and later involving the entire lower limb. In the early stage, protein-rich lymph fluid accumulates in the tissue spaces, forming soft indented edema, and the skin is still normal. In the late stage, due to the accumulation of protein in the tissue spaces, inflammation and fibrosis of subcutaneous tissue, and other reasons, the edema becomes non-indented, the skin thickens, dries, becomes rough, hyperpigmentation occurs, and warts or spiny-like objects appear.

　　The degree of lymphedema is divided into:

　　1, Mild

　　Limb edema is indented, after elevating the limbs, the edema can decrease or disappear, and there is no fibrosis-like damage to the skin.

　　2, Moderate

　　The edema pressure no longer indents, limb elevation does not show significant edema regression, and the skin has moderate fibrosis.

　　3. Severe

　　Skin changes similar to elephantiasis appear.

　　Secondary lymphedema often has recurrent lymphangitis and gradually worsening lymphedema. When lymphangitis occurs, there are local redness, swelling, pain, lymph node enlargement, tenderness, and often accompanied by sudden chills and high fever.

　　Prevention of lower limb lymphedema:The prevention and treatment of mosquitoes and filariasis are the main measures to prevent lymphedema caused by filariasis infection. For lymphangitis caused by Streptococcus hemolyticus infection, the initial attack should be thoroughly treated, the dosage of antibiotics should be sufficient, and the course of treatment should be appropriately prolonged. Tinea pedis is a common factor for pathogenic bacteria invasion, and should be actively treated. Regular physical examinations, enhance immunity and physique, and seek medical attention in a timely manner if the condition is found.

　　For patients with unknown causes of lower limb swelling, in order to exclude or differentiate the causes of lymphatic lesions, radioactive isotope lymphangiography and lymphangiography can be performed. The latter includes two methods: direct method and indirect method. The direct method is to inject methylene blue into the subcutaneous tissue of the toe web to make the lymphatic vessels visible, and then puncture and inject iodine contrast agent after exposure through a superficial skin incision; the indirect method is to inject an absorbable contrast agent into the skin of the edematous area and then take a film.

　　Patients with lower limb lymphedema can eat beef tenderloin, which is a piece of lean meat inside the backbone. The meat is tender and suitable for stir-frying, slip sauce, and other dishes. Abstain from smoking, drinking, coffee, spicy, and刺激性食物.

　　Firstly, the Principles of Treatment

　　1. Elevate the affected limb, compress and bandage.

　　2. Limit water, sodium intake and the use of diuretics.

　　3. Treatment of filariasis or erysipelas.

　　4. Hot Packing Treatment.

　　5. Surgical Treatment: The methods include lymphovenous or lymph node-vein anastomosis. Pedicle omentum transplantation. Skin grafting after resection of the lesion.

　　Secondly, the Principles of Drug Use

　　This disease has no effective drug treatment, mainly relies on physical therapy. If edema is caused by filariasis or erysipelas, choose the treatment drugs for filariasis or erysipelas.