Complex decongestive physiotherapy for pretibial myxoedema.

227 Lymphoedema is a chronic, debilitating disorder resulting from congenital abnormality of the lymphatic system (primary lymphoedema) or acquired causes (secondary lymphoedema). Complex decongestive physiotherapy is the ‘mainstay’ intervention for lymphatic insufficiency comprising manual lymph drainage, in selected cases intermittent pneumatic compression, multilayered compression bandaging with appropriate padding, exercise, and meticulous skin care (Consensus Document of the International Society for Lymphology 2003). Manual lymph drainage encourages fluid mobilisation, protein reuptake from interstitial space, and softening of fibrotic tissue. Pneumatic compression aids manual drainage. Short-stretch bandages have low resting and high working pressure, which means that contracting muscles will be compressed and aid lymph flow. Exercise while using multilayered compression also aids manual lymph drainage. Once active therapy is completed, patients continue maintenance therapy with custom-fitted stockings. As symptoms become more severe, the active phase has to be repeated.