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Lymphatic circulation

How does the lymphatic system works

The lymphatic system is a system of lymph nodes and lymph vessels involved in the body’s immune defense system and performing an exchange function (lymph transportation). 

The most important parts of the lymphatic system are the bone marrow, spleen, lymph nodes and tonsils.

Other organs, including the heart, lungs, intestine, liver and skin also possess a lymphatic system.

The thoracic duct is also part of the lymphatic system, starting near the lower portion of the spine and accumulating lymph from the lower limbs, pelvis, abdomen and the lower part of the chest.

Lymphatic system abnormalties

Dynamic Insufficiency: the lymphatic system is intact but has to cope with a protein load that is higher than its carrying capacity.
Mechanical Insufficiency: the lymphatic system no longer works and excess lymph is not reabsorbed.

Lymphedema: a syndrome of extravascular accumulation of lymph or alteration of the lymph vessel and altered lymph formation that leads to water and protein stagnation. Primarily evidenced in the upper and lower limbs (generally being asymmetric in only one of the two) but it can also develop in the genital zone. Lymphoedemas must be distinguished from other types of oedema, especially in the lower limbs, which can have different causes such as venous, heart and kidney pathologies. The characteristics of lymphedema is that it is an evolving pathology that progressively worsens with the passage of time, leading to fibrosis, an increase in tissue hardness and consistency due to the high concentration of proteins contained in the fluid. Lymphedema can cause limb volumes to increase even 2-3 times more than normal, leading to difficulty in moving and bending the limb.

Causes of lymphedema

Lymphoedema is caused by insufficient lymphatic system drainage due to primary or secondary damage to the lymphatic system that creates an accumulation of water and proteins.  Lympheodema must be distinguished from other types of edema, especially in the lower limbs, which can be due to other causes (vein diseases, cardiac, kidney or liver insufficiency and many other conditions that favor accumulation of liquids in the interstitial tissue).

Lymphoedemas are classified as primary and secondary.  What is the difference?
Primary lymphoedemas are characterized by alterations to the development of the lymphatic system.  The damage is congenital meaning that it shows basic alterations such as a low number of lymph nodes or lymph vessels.  Swelling can begin even many years after birth (lymphoedema is called precocious if it appears before 35 years of age and late if it appears after this age).
Secondary lymphoedema is when alterations to the lymphatic system come from various causes:  post-trauma, infections, surgery, tumors.
The main cause of lymphedema in the world, although very rare in our country, is due to the filarial infestation, a worm transmitted by a mosquito bite.  In western countries the main cause of lymphedema is cancer due to the removal of lymph nodes or following radiation treatment.

Progress of lymphodema

The progress of both primary and secondary lymphoedema is characterized by stages:



  • Initial latent period (absence of clinical symptoms) 
  • Manifestation of mild soft edema which: regresses in whole or in part during the night and/or with the lower limbs raised (Trendelenburg position)
  • Oedema on the back of the foot (called a pincushion)
  • Accentuation of natural skin folds at the metatarsophalangeal joints (Stemmer’s sign)


  • Occasional cramps, especially at night, tingling, sometimes itching.
  • Can be confused with other patologies.

II° STAge:


  • Hard swelling, namely:
    1. no depression is formed when exerting pressure with your fingers
    2. no tendency to regress
    3. is ingravescent (gets more serious and can give rise to fibrosis if left untreated).
  • The skin surface is:
    1. dry
    2. hyperkeratotic (the stratum corneum of the skin increases in thickness) grayish in color.


  • Heaviness, cramps, itching
  • Increasingly persistent, especially during the evening



  • Fibrolymphoedema, “rigid” limb with hardened subcutaneous layer and trophic disorders (sclerosis-induced pachydermitis and lymphostatic verrucosis).
  • Persistent stagnation of interstitial fluid with high protein and catabolite content
    1. formation of fibroblasts
    2. tissue fibrous (fibromatosis).


  • Heaviness, strong tingling, persistent cramps, intense itching, skin tension

Treatment of lymphoedema

The oedema is soft when compressing it with a finger causes a dimple (only water is present) or hard when compressing it does not show a dimple (presence of water bonded with proteins).
Every oedema with the passage of time, tends to increase its share of proteins.  This is why it should be treated as quickly as possible.
Oedema treatment, whatever the cause, is based on compression (elastic, manual, pneumatic) that is exerted in proportion to its gravity, applying this compression to the swollen part of the afflicted limb.  Compression serves to facilitate lymph passage in the lymph vessel and also to facilitate reabsorption of the lymph.

Compression therapy of lymphoedema

Compression therapy of lymphoedema takes place in three phases:

  1. Reduce the oedema in order to eliminate its “mobile”, and easily eliminated, fluid part. This is generally done with bandages assisted by lymphodrainage of the lymph node sites, drug therapy and gymnastics.
  2. Maintenance of results, preventing more fluid from accumulating and increasing, with time, fibrosis.  This is achieved using elastic stockings, manual lymphatic drainage, pressotherapy and gymnastics.
  3. Unfortunately lymphoedema is a disease for which there is no cure.  However it can be controlled:  after attack therapies, the lymphoedema is kept under control using elastic compression wrist wraps or stockings and by complying with a few behavioral rules.

Solidea offers a wide collection of products that maintain the results achieved by treatments which reduce lymphoedema.
Reappearance of edemas in the lower limbs can be prevented by using graduated compression elastic stockings and tights.
Class II therapeutic compression (25 – 32 mmHg) is recommended in cases of reversible lymphoedema.  The Solidea Therapeutic line offers:

Also available in Plus Line versions (used in cases of exceptional increases in the girths of lower limbs).

Class III therapeutic compression (24 – 46 mmHg) is recommended in cases of irreversible lymphoedema. The Solidea Therapeutic line offers:

Also available in Plus Line versions (used in cases of exceptional increases in the girths of lower limbs).