Disorders of lymph drainage

Disturbances of lymphatic drainage develop in cases of lymph node involvement (inflammation, scarring, metastases, tumors), blood vessels (inflammation, compression, trauma, malformations), ducts (usually a fracture in the form of a rupture) or due to functional disorders in diseases of other organs and systems (allergy , phlebogertonia, renal, hepatic and cardiac failure, etc.). Disturbance of lymph drainage can be acute (temporary) and chronic.

The main manifestation of impaired lymph flow is the formation of edema. Compensatory capabilities of the lymphatic system are very large (an increase in the number of capillaries, vasospasm with slowing lymph circulation, the discovery of collaterals, the discharge of excess lymph into the venous system, etc.). This allows you to quickly stop the swelling. Only in separate organs and systems, mainly with a mechanical obstruction, the outflow of lymph can be so significant that lymphostasis develops with the formation of lymphedema and elephantiasis, lymphorrhea and hiluria,

Lymphedema is a lymphatic edema that develops as a result of impaired lymph flow from the body area, more often of the lower extremities, less often of the upper extremities, external genitalia and face. Unlike conventional edema, the formation of protein coagulum occurs in the lymphatic and interstitial tissues, eventually leading to complete obstruction of the lymphatic vessels and nodes.

Disturbances of the lymph drainage occurs during blockage of the lymph nodes, ducts and main vessels due to scar compression or germination, surgical intervention with the removal or ligation of vessels and nodes, the effects of inflammation in them, trauma (especially often with the imposition of compression-distraction apparatus), venous outflow disorder (obliteration of veins, chronic venous insufficiency).

A dense, hard-to-pierce edema forms, leaving dents in the area of squeezing with fingers, which disappear after a few minutes or even hours. Edema by volume and density is not constant: increases in, the warm season, after physical exertion; decreases in the autumn-winter period and after a long rest. The skin is predisposed to trophic changes, up to the development of the specimen with lyseo, and inflammatory changes, which leads to increased edema and heavier flow.

Elephancy is the final phase of impaired lymphatic drainage and lymphostasis in the limb or extremities (mainly the lower ones), accompanied by a persistent diffuse increase in volume due to irreversible fibrotic changes in the subcutaneous tissue, fascia and skin.

It is mainly formed in women at a young age, often imperceptibly and gradually. It begins with the foot and spreads in the proximal direction. Clinic of impaired lymph drainage is not expressed in the initial phases: limb fatigue, doughness of the consistency of the skin and subcutaneous tissue, increase in volume. To a greater extent, patients are concerned with cosmetic defect, especially with unilateral limb injury, due to asymmetry. Gradually, the transient edema becomes permanent, first there are intermittent areas of soft and dense edema, then generalized feciformum is formed (the swelling is dense and not squashed). Sometimes the proliferation of tissue in the form of deforming formless tubercles. Often join and trophic disorders.

Lymphorrhea - disorders of the lymph drainage, characterized by the flow of lymph from the vessels and trunks due to trauma or disease.

With open lesions, lymph is released from the wound by drops, then by a stream initially transparent or colored with blood, then cloudy. With closed ruptures of lymphatic vessels, lymphatic accumulation takes place in the intermuscular spaces and surrounding tissues with the formation of edema or lymphedema. With closed lesions of the thoracic lymphatic duct, depending on the level of rupture, chylothorax, pericarditis, peritonitis can be formed. Very rarely, with lymphostasis, lymphoangiectasis is formed from the capillaries in the skin, accompanied by limforea. In this case, deep trophic disorders do not occur in the skin, edema is limited and mild.

Usually lasts from a few hours to; several days, but with damage to large vessels can lead to depletion of the patient due to the loss of large amounts of water, salts, protein and fats. When pouring into the cavity, purulent inflammation of these cavities may join.

To determine the violation of lymph drainage and damage to the vessel and its level, especially during the operation, intravenously inject drugs staining lymph (indigocarmine, methylene blue, Evans paint) or for 2 hours fed with fatty mixtures (BV Ognev's technique).

[1], [2], [3], [4], [5], [6], [7], [8], [9]