Robert Harris
Senior instructor
Dr. Vodder School - International
www.vodderschool.com
Acknowledgements / Affiliations
 Animations and Movie clips
 Prof. Neil Piller, Flinders
University: Vital Essence CD
 Affiliations
 Dr. Vodder School International:
director and senior instructor
 BCLA: Advisory Board
 Canadian Lymphedema
Framework: Advisory Board
 Lymphedema Association of
Ontario: Advisory Board
BCLA conference 6/25/11 R. Harris
Physiology behind Lymphedema
 Overview:
 Normal fluid movement in the tissues
 How fluid accumulates
 What types of problems can arise
 Why lymphedema occurs
 How lymphedema progresses
BCLA conference 6/25/11 R. Harris
Normal fluid movement
 Lymph vessel system responsible for removal from
tissues of:
 fluid
 proteins
 cell debris
 waste matter
 pathogens
(bacteria and viruses)
BCLA conference 6/25/11 R. Harris
Normal fluid movement
• Fluid leaving blood capillaries is
mostly taken up by lymph vessels
Courtesy: Flinders University, Vital Essence CD
BCLA conference 6/25/11 R. Harris
Normal fluid movement
 Balance in tissues
J.R. Levick: Revision of the Starling Principle: new views of tissue
fluid balance. J. Physiol. 553.3 (2004) p.704.
BCLA conference 6/25/11 R. Harris
How fluid accumulates in lymphedema
Courtesy: Flinders University, Vital Essence CD
•Normal amount of fluids leaving blood capillaries
•Problem in lymph system
•Fluid levels rise in tissues
BCLA conference 6/25/11 R. Harris
What types of problems can arise?
 With reference to lymphedema:
 Mechanical insufficiency of the lymph vessel system


Primary: chronic edema caused by a developmental
abnormality of the lymphatic system.
Secondary: acute or chronic edema caused by obstruction,
damage, trauma, inflammation
BCLA conference 6/25/11 R. Harris
Types of lymphedema
 Primary lymphedema:
 Born with insufficiency of lymph vessels
 Insufficient lymph vessels to manage normal amount of
fluid being produced in tissues
 Edema can develop years later or soon after birth
BCLA conference 6/25/11 R. Harris
Types of lymphedema
 Primary lymphedema:
 Milroy’s (10%), hereditary, manifests at birth typically in feet and
lower legs. Thought to be a functional impairment of lymph vessels
rather than aplasia or absence of lymph vessels (F. Connell: ILF
conference 2011).
BCLA conference 6/25/11 R. Harris
Types of lymphedema
 Primary lymphedema:
 Meige’s (90%): sporadic,
generalised lymphatic dysplasia
(abnormal growth). Edema
typically occurs in puberty or
later.
BCLA conference 6/25/11 R. Harris
Types of lymphedema
 Secondary lymphedema:
 Insufficient lymph vessels to
manage normal amount of
fluid being produced in tissues
 An acquired cause (e.g. surgery,
radiation, trauma, malignancy)
BCLA conference 6/25/11 R. Harris
Types of lymphedema
 Secondary lymphedema:
 Acute: e.g. immediately after surgery or trauma lasting
up to 6 months (Weissleder)
 Chronic: can develop months or years after damage to
lymph vessel system
Courtesy: Flinders University, Vital Essence CD
BCLA conference 6/25/11 R. Harris
Why does lymphedema occur?
Summary
 Normal amount of fluid entering tissues from blood
capillaries
 Either too few or abnormal lymphatics to take away
fluid resulting in primary lymphedema
 Damage, inflammation or blockage of lymph vessels
resulting in secondary lymphedema
BCLA conference 6/25/11 R. Harris
How lymphedema progresses
 Latent Phase
 Problems with lymph vessels but able to handle amount
of fluid being produced
 Decreased capacity of lymph vessels
 No visible edema
BCLA conference 6/25/11 R. Harris
How lymphedema progresses
 Stage One
 Problems with lymph vessels and not able to take away
enough fluids in tissues
 Transport capacity exceeded
 Accumulation of proteins in tissues
 Visible edema, reversible
BCLA conference 6/25/11 R. Harris
How lymphedema progresses
 Stage Two
 As in Stage One but not
reversible on elevation
 Fibres laid down in tissues
 Chronic inflammatory
processes
Courtesy: Flinders University, Vital Essence CD
BCLA conference 6/25/11 R. Harris
How lymphedema progresses
 Stage Three
 As in Stage Two
 Thickened, hard skin
 Fibrosis of remaining lymph
vessels, blood vessels and
nerves
BCLA conference 6/25/11 R. Harris
Conclusion
 Lymph vessel system removes normal fluids from
tissues
 Mechanical problem with lymph vessels results in
impaired drainage
 Accumulating fluids and proteins results in
progressive severity of lymphedema
 Early intervention to prevent progression!
BCLA conference 6/25/11 R. Harris