Lymphatic flow disorders

Lymphatic drainage disorders develop when the lymph nodes are affected (inflammation, cicatricial shrinkage, metastases, tumors), vessels (inflammation, compression, trauma, malformations), ducts (usually trauma in the form of a rupture) or as a result of functional disorders in diseases of other organs and systems (allergy, phlebohypertension, renal, hepatic and cardiac failure, etc.). Lymphatic drainage disorders can be acute (temporary) and chronic.

The main manifestation of lymphatic drainage disorder is the formation of edema. The compensatory capabilities of the lymphatic system are very large (increase in the number of capillaries, vascular spasm with slowing of lymph circulation, opening of collaterals, discharge of excess lymph into the venous system, etc.). This allows for rapid relief of edema. Only in certain organs and systems, mainly with mechanical obstruction, can the lymph outflow be so significant that lymphostasis develops with the formation of lymphedema and elephantiasis, lymphorrhea and chyluria,

Lymphedema is a lymphatic edema that develops as a result of impaired lymph drainage from a body part, most often the lower extremities, less often the upper extremities, external genitalia and face. Unlike normal edema, protein coagulate forms in the lymphatic pathways and interstitial tissue, eventually leading to complete obstruction of the lymphatic vessels and nodes.

Disturbances in lymphatic drainage occur when lymph nodes, ducts and main vessels are blocked due to compression or tumor growth through scars, surgical intervention with removal or ligation of vessels and nodes, consequences of inflammation in them, trauma (especially often when applying compression-distraction devices), and venous outflow disorders (vein obliteration, chronic venous insufficiency).

A dense, difficult to press through edema is formed, leaving dents in the area of finger pressure, which disappear after a few minutes or even hours. The edema is not constant in volume and density: it increases in the warm season, after physical exertion; it decreases in the autumn-winter period and after a long rest. The skin is predisposed to trophic changes, up to the development of eczema with lymphorrhea, and inflammatory changes, which leads to increased edema and aggravation of the course.

Elephantiasis is the final phase of impaired lymph flow and lymphostasis in a limb or limbs (mainly the lower ones), accompanied by persistent diffuse increase in volume due to irreversible fibrous changes in the subcutaneous tissue, fascia and skin.

It develops mainly in young women, often unnoticed and gradually. It starts from the foot and spreads in the proximal direction. The clinical picture of lymphatic drainage disorder is not expressed in the initial phases: limb fatigue, doughy consistency of the skin and subcutaneous tissue, increased volume. To a greater extent, patients are concerned about it as a cosmetic defect, especially with unilateral limb damage, due to asymmetry. Gradually, transient edema becomes permanent, at first alternating areas of soft and dense edema are noted, then generalized febredema is formed (the edema is dense and does not press through). Sometimes tissue proliferation in the form of deforming shapeless tubercles. Trophic disorders often join in.

Lymphorrhoea is a disorder of lymphatic drainage, characterized by the leakage of lymph from vessels and trunks due to injury or disease.

With open injuries, lymph is released from the wound in drops or a stream, initially transparent or stained with blood, then cloudy. With closed ruptures of the lymphatic vessels, lymph accumulates in the intermuscular spaces and surrounding tissues, forming edema or lymphedema. With closed injuries to the thoracic lymphatic duct, depending on the level of the rupture, chylothorax, pericarditis, and peritonitis may form. Very rarely, with lymphostasis in the skin, lymphangiectasias form from the capillaries, accompanied by lymphorrhea. In this case, deep trophic disorders in the skin do not occur, the edema is limited and soft.

Usually lasts from several hours to several days, but if large vessels are damaged, it can lead to exhaustion of the patient due to the loss of a large amount of water, salts, protein and fats. If it spills into cavities, purulent inflammation of these cavities can join.

To determine the disruption of lymph flow and damage to the vessel and its level, especially during surgery, drugs that stain the lymph (indigo carmine, methylene blue, Evans dye) are administered intravenously or the patient is fed fatty mixtures 2 hours before (B.V. Ognev's method).

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