Manual lymphatic drainage (MLD) as we know it is a specialised type of skin massage that can help to reduce lymphoedema. As technology advances, new knowledge leads to better methods of treatment. Fluoroscopy guided manual lymphatic drainage is a new and exciting type of MLD.
What is it?
Fluoroscopy guided manual lymphatic drainage uses specific techniques to help move lymph fluid to reduce the swelling. It is called the ‘Fill and Flush’ method.
FG-MLD is a way of doing manual lymphatic drainage based on research that used a new test. This test is called mapping of the lymphatics. It shows how fluid moves through the drainage vessels just under the skin (the superficial lymphatics) and how it builds up in certain areas.
The test allowed researchers to identify lymph drainage pathways that work and those that don’t. They also found other drainage routes that can take over when certain channels get blocked.
The research helped people who do MLD to develop hand movements that can work better in moving the fluid away from swollen areas.
Lymphoedema therapist need special training to do FG-MLD, which I have done.
How do we do it?
To treat your arm or leg, you normally will be lying down to have the MLD. If you have head and neck oedema, you will be sitting up.
When you have FG-MLD, the lymphoedema practitioner uses particular hand movements to encourage the lymphatic fluid to drain to a specific point. You will feel slightly more pressure on the skin. The skin movements are firm but comfortable, and will be done slowly and rhythmic
You might have FG-MLD daily from Monday to Friday. Or you might have it 3 times a week, for about 3 weeks, depending on your specific oedema.
The number of treatments you have depends on the amount and type of swelling you have. I will use my knowledge of FG-MLD to adapt the way I treat your swelling.
For some people, having the lymphofluoroscopy mapping test can help the MLD to work better.
“Mapping of the lymphatics”
Lymphofluoroscopy mapping shows up problems with the flow of lymph after lymph node treatment. Treatments like surgery or radiotherapy can change the way lymph fluid usually drains.
Mapping your lymphatics an help you to have a better response to MLD. Your lymphoedema specialist will see the unique problems you have with the flow of lymph, especially in the area where you had cancer treatment. They can then work out an individual treatment plan for you.
It is however not necessary to do the mapping if you are unable to. I can still do the ‘fill & flush’ technique without the information of the mapping.
How do they do the Mapping?
You have a small injection of a fluorescent dye called indocyanine green (ICG). It is an intradermal injection, meaning that it will be done just underneath your skin. The specialist injects it into 2 places on your hand or foot depending on where you have swelling. The dye binds to the proteins in the lymphatic fluid.
The specialist then uses a special infrared camera over the swollen area where you were injected. The fluorescent dye in the lymph reacts to the infrared light, and then specialist can see the lymph channels.
You then leave for about 3 hours and exercise your arm or leg. This helps the specialist to see how far the dye has moved in your lymphatic system and shows up any blocked areas.
For a full mapping, you could be at the clinic for up to 4 hours.
Unfortunately, we cannot do the Mapping at MLC, but you can contact Dr Dimitri Liakos at Donald Gordon hospital for a consultation.
Mapping can pick up lymphoedema before you can !
Sometimes lymphofluoroscopy mapping can be done to screen people to spot lymphoedema early. By doing this, they can diagnose swelling before you can feel or measure it and treatment can start early. This can help to control the lymphoedema well.
Side effects of mapping
Lymphoedema mapping using the ICG dye is safe and very few people have side effects. The area where you’ve had the injection will appear green afterwards and stay like that for about 2 weeks.