The authors describe in detail lymphedema as an edema owing to an impaired lymph transport caused by interruption of lymphatic routes, infection or congenital abnormity. Moreover, possible complications of lymphedema, mainly development of secondary infections, are mentioned. An early and correct diagnosis using lymphoscintigraphy, ultrasound and CT examination is stressed both in primary and secondary lymphedema. Systemic enzyme therapy using combined mixtures of proteolytic enzymes (chymotrypsin, trypsin, bromelain, papain etc.) represents an effective treatment modality in pharmacotherapy of lymphedema. Enzyme therapy can improve already indurated and sclerotized tissue even in fully developed lymphedema. Based on the results of clinical trial in patients after breast cancer surgery it has been suggested that beginning of enzyme treatment immediately after surgery is an optimum therapeutic approach.
Postgraduální medicína 2003, 5 (6), pp. 626 – 633 , Lymphedema, authors: Kafková H., Kojanová M. (Department of Dermatovenerology, 1st Medical School of Charles University, Prague)