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During the course of the COVID-19 pandemic, lymphoedema and community clinicians have had to modify how they implement intensive treatments for patients with lymphoedema and chronic oedema. Using novel approaches to treat and move patients towards self-management regimes has enabled patients to be in control of their condition, particularly if they are unable to attend normal clinic appointments. This article explores how using Haddenham easywrap instead of time- and resource-intensive bandaging regimes, alongside the Haddenham LymphFlow Advance, as part of self-management programmes, can benefit patients' quality of life, reduce costs and resource use and enable patients to self-manage this long-term chronic condition more effectively.

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome—percentage tissue water—measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.

Lymphoedema management has evolved over many decades, but the core components of treatment remain largely unaltered, such as skin care, compression and self-lymphatic drainage. Near-infrared fluorescence lymphatic imaging (NIRFLI) offers an opportunity to enhance patient outcomes by evaluating and increasing the effectiveness of these treatment options. This is relevant when we consider the impact of this chronic condition and its endemic proportions ( Mortimer, 2014 ), while Moffatt et al (2017) suggests it is one of the biggest health risks in the Western world, due to the multiple causes, such as cancer, obesity and as a complication of an ageing population. The impact of the condition can be reduced through early identification and the risk-reduction strategies that NIRFLI can offer through greater understanding of its chronicity. The use of NIRFLI has also led to the development of a new manual lymphatic drainage technique to assist in the management of lymphoedema ( Belgrado et al, 2016 ). The aim of this article is to introduce and describe NIRFLI and its use within lymphoedema management. It will discuss use with early detection of lymphoedema and expand further, focusing on its use within the management of lymphoedema.

Improving microcirculation in the area of a wound is an important aspect of wound healing. It can be improved by a new manual methodology: myofascial-manual lymphatic drainage (M-MLD). This hybrid technique uses elements of musculoskeletal medicine and manual lymphatic drainage. Through palpation, M-MLD therapeutically affects the functional pathology of soft tissues, with reflection in trigger points, and also the functional pathology of lymphatic system, namely by lymphostasis in particular regional lymph nodes. Most cases of post-traumatic and postoperative conditions lead to dynamic insufficiency of the venous system and subsequently of the lymphatic system. If this is not treated promptly, it can lead to secondary post-traumatic lymphoedema. Early M-MLD treatment eliminates the development of secondary post traumatic lymphoedema and even secondary inflammation, thus decreasing the risk of cicatrix hypertrophy and contributing to faster wound healing and better regeneration of the afflicted area. Laboratory immunological examination of circulating immune complexes support 20 years of the authors' empirical experience. The level of circulating immune complexes before M-MLD reached constant values. After manual influencing of the functional pathology of soft tissue and lymphatic system, the dynamics of circulating immune complexes levels was observed, this is the effect of the improvement of microcirculation in the wound area. M-MLD is time- and cost-saving, but it requires professional training with a very good palpation technique. In the authors' experience, its use is indicated within 2–24 hours from the time of trauma (surgery), and then once a day until healing is achieved. This early manual therapeutic treatment can be delivered not only by physiotherapists, but also nurses working to encourage wound healing, such as in traumatology, surgery and orthopaedics. Using M-MLD makes the total treatment time shorter, and has an economical, biopsychosocial and society-wide impact.

Lipoedema is a chronic progressive adipose disorder that affects mainly women and presents as symmetrical enlargement of the buttocks and legs. It is commonly misdiagnosed as obesity or lymphoedema, but careful assessment will reveal a disproportionate enlargement below the waist which is resistant to dieting, sparing of the feet, legs are tender or painful to touch and bruise easily, there is occasional orthostatic oedema, and there is often significant psychological morbidity. Lipoedema is a oestrogen-regulated condition with onset around puberty in 78% of women, and there is often a strong family history. The condition is exacerbated by weight gain and there is increasing anecdotal evidence that women who are obese are seeking a diagnosis of lipoedema, either to procure NHS funded manual lymphatic drainage, or to medicalise their obesity and avoid acknowledging that the responsibility for their weight gain is lifestyle orientated. Management of lipoedema consists of accurate diagnosis, psychological care, management of orthostatic oedema, and prevention of progression through skin care and weight management.

While there is no proven cure for lipoedema, early detection is key as specialist treatments, complemented by self-management techniques, can improve symptoms and prevent progression. There is no universal approach as the correct treatment or treatments will depend on each patient's particular circumstances; however, when chosen early and appropriately, interventions can provide huge benefits. The most common treatments in the management of lipoedema include compression, manual lymphatic drainage (MLD), tumescent liposuction, intermittent pneumatic compression therapy (IPC), kinesio taping, deep oscillation therapy, and cognitive behavioural therapy (CBT).

As more women are surviving breast cancer, long-term complications of treatment that affect quality of life, such as lymphoedema, gain greater importance (Tsai et al, 2009). The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), and sometimes surgery. The increasing number of women who survive breast cancer partnered with the tendency to care for more patients in the community mean that community nurses may find themselves at the forefront of the management of this patient group, becoming more responsible for side-effects of treatment and the disease. This article will discuss lymphoedema, its treatments along with relevant evidence, illustrating current practice.

This article aims to review the function of the lymphatic system, what lymphoedema is and how this condition can be treated. It identifies the differences between oedemas with the emphasis on pure lymphoedema. Topics covered include differentiating between oedemas, basic treatment plans, the importance of early detection and appropriate referral to specialist practitioners. It highlights the need for all health professionals to have some understanding and awareness of this chronic condition.

The treatment of lymphoedema is extremely patchy in the UK with some areas having very good and experienced teams and some areas having no one at all. Community nurses will come across an assortment of lymphoedema cases, often not being dealt with properly due to a lack of knowledge or expertise in their area. With access to the Internet, nurses can go to the British Lymphology Society (BLS) or the MLDUK websites and have a look at their list of qualified therapists. This article sets out to explain some of the differences and the similarities between training and to provides some tools for choosing the most appropriate manual lymphatic drainage/lymphoedema therapist.