Lymphedema Management: A Comprehensive Guide For Practitioners
NEW YORK:THIEME MEDICAL PUBLISHERS INC., 2005
Author: Joachim E. Zuther, CI

Review in Lymph Link, Official Organ of the National Lymphedema Network, Volume 17, Number 2, April-June 2005
Reviewed by: Kathleen Francis, MD

This textbook is a concise but comprehensive review of lymphedema and related disorders covering anatomy, physiology and treatment. The book is relevant both to practitioners experienced in the field and those who wish to learn more about the lymphatic system and the pathophysiology and management of lymphatic insufficiency.

The text is well written and extremely well organized, with color-coded tabs distinguishing each chapter for quick reference. The chapters are laid out in a logical sequence, beginning with chapters on anatomy and physiology of the lymphatic system, progressing to pathophysiology of lymphedema, associated conditions and treatment, and finally, administrative and documentation issues. The chapter on administration even includes sample forms and templates that may be useful for many practitioners. Within each section of the book, colored text boxes summarize and highlight important concepts.

There are plentiful illustrations, photographs and tables throughout the volume, both in color and black and white. Descriptive legends are written clearly with a minimum of highly technical language in order to make them accessible to a varied readership. A glossary at the end of the textbook also helps define many of the terms which may be unfamiliar to non-medical readers. The anatomy chapter that begins the book is an excellent review of both the micro- and macro-anatomy of the lymphatic system including components of the system and drainage pathways. The section on physiology deals with capillary and fluid dynamics and explains the basis of lymphatic insufficiency. A discussion on the pathology of LE covers etiologies, stages, and complications of lymphedema, as well as co-morbidities, diagnostic approaches, and an introduction to various treatment modalities. An entire chapter on Complete Decongestive Therapy (CDT) and a chapter on treatment of lymphedema affecting specific body parts describe and illustrate MLD techniques and compression therapy including bandaging and compression garments, and discuss exercises and skin care. While these chapters may not replace more detailed and comprehensive manuals on CDT techniques, they provide an excellent review for therapists and a detailed introduction for those who are unfamiliar with the specifics of CDT. Patients and the therapists who instruct them will benefit from a well-illustrated section on self-MLD and instructions for lymphedema exercises.

In summary, although this textbook is compact with 270 pages, it manages to cover all the important aspects of lymph-edema and its treatment in a clear, concise, well-organized manner with plenty of photos and illustrations to augment the text. This book can be highly recommended as a review and reference for therapists, physicians and other health-care providers, and to non-medical per-sons who wish to increase their under-standing of LE (see page 30).



Lymphedema Management: The Comprehensive Guide for Practitioners
Zuther JE.
New York, NY 10001, Thieme, 2005, hardcover, 270 pp, illus, ISBN: 1-58890-284-6, $69.95.

Review in: Physical Therapy, Volume 85, Number 9, September 2005
Reviewed by: Nicholas F Quarrier, PT, OCS Ithaca College Ithaca, NY Mr. Quarrier is a Clinical Associate Professor for the Department of Physical Therapy and teaches courses in soft-tissue examination and intervention, and is certified in lymphedema therapy.

Zuther has provided a comprehensive, well-written textbook that is clear and concise. The organization is exceptional; each chapter is color-coded for ease in locating or browsing through information, and colored shadings in the text emphasize important points. Numerous clear, color, or black-and-white photographs and line drawings are placed throughout the book. Each chapter ends with a list of recommended readings, and there is a glossary and index at the end of the book. The text provides an in-depth description of the lymphatic system's anatomy, including the drainage and circulation patterns of lymph fluid. Lymph physiology and lymph pathology are explained, including topics such as chronic venous insufficiency, lipedema, traumatic edema, and lymphedema.

The effects of radiation and surgery on the lymphatic system are discussed, along with illustrations of primary and secondary lymph-edema. Three quarters of the textbook reviews and examines interventions, such as complete decongestive therapy and manual lymph drainage. Administrative topics, such as reimbursement and billing, are presented in the last chapter, along with non-copyrighted sample forms and templates on issues such as health information consent and privacy rules.

The manual lymphatic drainage techniques described in this text are based on the Vodder techniques. The basic strokes (e.g., stationary circles, pump, scoop, and rotary) are described and illustrated. Regional drainage sequences are reported and illustrated in a step-by-step fashion.

Extensive bandaging and garment issues also are well described and illustrated. A very clear description of patient self-bandaging, self-drainage, and exercises is provided. The "dos and don'ts" for both upper- and lower-extremity lymphedema are listed. Various bandaging product brands are mentioned, but the author does not recommend specific brands of bandages or compression garments. The text has a few limitations. The author describes a fairly strict protocol consisting of the Vodder style of manual lymph drainage and does not present other drainage styles and protocols. For example, the use of pump points, "U" strokes, and kinesiotaping are not mentioned. The recommended readings cited in each chapter are limited. A number of points are made with no literature references; however, the majority of references documented are from recent peer-reviewed journals. Some references in the pathology chapter are evidence-based, but, in the discussions about techniques, there are no evidence-based practice references.

In summary, this text provides an excellent description of the lymphatic system and its pathologies and a description of manual lymphatic drainage interventions, including complete decongestive therapy. Regardless of their level of experience in lymphedema management, clinicians who are interested in the Vodder style of intervention will find this book very useful because they can use it in refining their skills and protocols. Clinicians who treat Lymphedema using an eclectic approach will find this text limited but overall an important book for their library, whereas students and patients interested in this topic will find exceptional value in reading this book. The quality and readability are excellent.

Lymphedema Management: The Comprehensive Guide for Practitioners
Zuther JE. New York, NY 10001, Thieme, 2005, hardcover, 270 pp, illus, ISBN: 1-58890-284-6, $69.95.

Review in: Massage Magazine November/December 2005, page 134
Reviewed by: Charlotte Michael Versagi, L.M.T., N.C.T.M.B., M.L.D./T., president of the American Massage Therapy Association’s Michigan chapter, a clinical supervisor in a hospital oncology massage program, a lymphedema specialist, and on faculty of a massage-therapy program teaching pathophysiology and massage modalities.

Up until now, one of the most charismatic and knowledgeable instructors in the management of lymphedema has been silent in the publishing field. We know of Bruno Chikly and Emil Vodder – but where was Joachim Zuther? With his extensive training in lymphedema management, his successful lymphedema clinic in Florida, his two-week training curriculum at the Academy of Lymphatic Studies, and his world lymphedema training tour, Zuther has finally joined the ranks of Chikly and Vodder in producing a wonderfully comprehensive guide for those who love the lymphatic system as much as he does.
The book begins with the requisite detailed anatomy and physiology of this elegant, complicated, hidden and often misunderstood system. The first two chapters are nicely illustrated, extensively referenced and logically understandable for those who come to the table with a love and a previous study of this area. It is doubtful anyone specializing in another massage field would pick this book up for light reading; thus, this complex text is not intended for fireside reading. For seasoned lymphedema management practitioners, understanding “watershed flow” is not rocket science – but getting the basics of capillary exchange can be tricky. Zuther walks us through all of it with pictures, diagrams and carefully crafted text.
The chapter covering lymphedema is brilliant; no one can believe the grotesque proportions a human body can acquire when one system goes bad, and the graphic photographs show just how devastating this condition can be. In the same chapter, Zuther discusses complete decongestive therapy and the other not-so-effective therapies used to treat lymphedema. There are many forms of swelling in the body that mask as primary or secondary lymphedema, including lipedema, traumatic edema, inflammatory rheumatism and Reflex Sympathetic Dystrophy, and Zuther covers these along with wounds and chronic venous insufficiency.
The next two chapters illustrate, and demonstrate in glorious detail, the step-by-step bandage-wrapping and hands-on techniques used to treat lymphedema. The pictures are very helpful, as this is a complicated process; sometimes it is all but impossible to figure out how to wrap a body part. (The male genitalia are one example of this. Zuther uses several photographs indicating how to care for this area, which is often involved when males undergo prostate surgery, were born with primary lymphedema or experienced pelvic-region trauma.)
The two surprising bonuses in the book are chapters on “Patient Education” and “Setting up a Lymphedema Clinic”. Zuther generously shares sample charts, patient and model-release forms, and measuring charts to help practitioners and physicians in this field.
I was fortunate to sit in on a two-week intensive lymphedema training at the Academy of Lymphatic Studies, given by Mr. Zuther. Taking notes at the speed of light, I was intellectually exhausted at the end of each day and kept thinking the whole time, “Why doesn’t this guy just write a book?” Thank you Mr. Zuther.