Complex Decongestive Therapy (CDT)
WHAT CAN BE DONE TO HELP?
If your doctor has diagnosed that you have lymphoedema, you should be referred to a fully trained and certified lymphoedema therapist.
The treatment you will receive is known as Complex Decongestive Therapy (CDT). CDT is regarded as the treatment of first choice in the management of lymphoedema and consists of two phases, symbolised here by the two circles.
Phase 1 - Intensive Phase (blue)
Phase 2 - Maintenance Phase (green)
Phase 1 - the Intensive Phase aims to reduce the swelling as much as possible, and to start to break down any fibrosis which may have developed. You will also be taught skills to help you to manage your condition.
Phase 2 - the Maintenance Phase aims to maintain and further improve the treatment outcome of Phase 1.
PHASE 1 - the Intensive Phase of treatment must include the following four components:
(i) Manual Lymphatic Drainage (MLD)
MLD is a gentle manual treatment that improves the function of the lymphatic system. MLD gently mobilises lymph out of a swollen area into healthy lymph vessels that drain into the blood stream.
(ii) Skin and nail care
A common complication of lymphoedema is that there is an increased risk of infection such as cellulitis. Careful skin, nail care and hygiene are essential to minimise the occurrence of such infections.
(iii) Multi-layer compression bandaging
The use of multi-layered bandages increases the tissue pressure and helps to prevent the re-accumulation of swelling between treatments. Bandaging can also help to break down areas of fibrosis and reshape the limb until it is ready to be fitted with a medical compression garment.
(iv) Remedial Exercises
The bandaged limb should be exercised regularly. Exercise activates the muscle and joint pumps of the affected limb, which over time can further help to reduce any swelling.
It is necessary that all four components are carried out during your treatment, regardless of the severity of your swelling. With patients' full cooperation expertly performed CDT should result in the swelling being reduced or almost eliminated.
HOW LONG WILL TREATMENT LAST?
The treatment takes approximately one-and-a-half hours per day for a minimum of two weeks in the early stages of lymphoedema. Treatment may last up to six weeks if your lymphoedema has become more advanced. This is because a greater amount of time is required to help improve the skin condition and to help break down and soften any fibrosis.
When your limb is as free as possible from swelling, you will be measured for a medical compression garment. To ensure an exact fit and correct compression - essential for effectiveness and comfort - it is recommended that you should be accurately measured for custom-made garments by your therapist or by specially trained personnel. (Fig.4)
Fig.4
Two garments should always be supplied to allow for washing and to enable you to wear your garment at all times during the day. Your compression garments should be replaced regularly by your therapist to ensure they remain effective.
PHASE 2 - The Maintenance Phase of treatment is 'life-long' and ideally should include six monthly checkups and further periods of intensive treatment (CDT) as required.
It consists of:
Wearing compression garments daily
Regular MLD as indicated by your therapist
Exercises to do at home
Skin and nail care
Self-treatment as indicated by your therapist
Fig. 5
When patients cooperate fully with Phase 2 of CDT, and especially wear their custom-made compression garments at all times during the day, they can keep swelling to a minimum. (Fig. 5)