Lymphoedema, the chronic accumulation of fluid in the interstitial tissues, is due to an insufficiency in the lymphatic system (British Lymphology Society, 2001). Most commonly, it involves one or more limb/s but an oedema of the trunk, head and neck or genitalia may also occur. Lymphoedema affects over 1.33 per 1000 of the population (Moffatt et al., 2003) and can have significant physical, psychosocial and economic implications. This chapter overviews relevant pathophysiology, outlines the causes of lymphoedema, explores the psychosocial impact and describes management strategies for lymphoedema.

Underlying pathophysiology

The lymphatic system is composed of a vast network of lymphatic vessels and over 700 lymph nodes, many of which are sited in regional groups at the neck, axillary and inguinal areas. The system transports excess fluid and proteins from the interstitial tissues to the blood circulation (Stanton, 2000) and also has an important immunological function. Networks of thin-walled lymphatic vessels lie in the dermis, supported by elastic fibres and anchoring filaments. Stimulated by local tissue movement, these lymphatics open, allowing fluid to pass into the system and drain via precollector and collector vessels through lymph nodes and into larger lymphatics, such as the thoracic duct, finally returning to the blood circulation (Földi & Földi, 2003). Lymph flow is influenced by contractions in the muscular wall of the collectors and ducts. Variations in local pressures due to pulsation of adjacent blood vessels and the skeletal muscle pump, along with changes in intra-thoracic and intra-abdominal pressures during breathing, also enhance lymph flow.