By Jose Maria Pereira de Godoy & Maria de Fatima Guerreiro Godoy
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39 This illustration demonstrates that the same pressure applied on the vessels evoked different reactions In both cases drainage occurred; however, in order to continue draining we needed to apply a greater pressure on the vessel in the lower position. The possibility of reflux was also greater in this vessel if the same pressure is maintained. Therefore, if we insist in continuing the drainage we will end by lesioning the vessel. Another important concept is that lymphatic vessels present valves and directed flow as demonstrated by the arrows.
Observe the axillar region receiving vessels from the upper limb, and the anterior thoracic wall. Attention to the drainage of the mammae towards the axillae. Drainage of the upper limb is initiated at the proximal region of the arm. 53 The basilic, pre-bicipital and cephalic currents may be drained in the anterior region. At the level of the fold of the elbow occurs The transition between the forarm and arm 54 Proceed with the drainage of the upper limb by draining the anterior radial, and anterior ulnar currents of the forearm.
These alterations occur in primary lymphedema. In secondary lymphedema, the initially intact lymphatic system is destroyed, as for example in surgery (lymph node emptying), filariasis and trauma. Mechanical lymphedema occurs in these cases. Such infirm tisssues, rich in proteins are propitious for the installation of infection, as by streptoccoci, which will further lesion vessels decreasing functional reserves. These patients should be evaluated by a specialist, to identify the type of lesion and the best therapeutic approach to be used.
A New Approach to Manual Lymphatic Drainage by Jose Maria Pereira de Godoy & Maria de Fatima Guerreiro Godoy