By Jose Maria Pereira de Godoy & Maria de Fatima Guerreiro Godoy
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Extra info for A New Approach to Manual Lymphatic Drainage
As we can observe, we have a superficial and a deep drainage going in different, but not opposite directions. We propose in this case, deep abdominal drainage using a rod in the region of the rectus abdominis in ascending direction, as shown in the illustration. This approach avoids the violation of the direction of the vessels of the abdominal wall. The abdominal wall is handled in the direction of the axilla. There are four proximal currents, two anterior, and two posterior. 59 Observe the inguinal chain which receives the lymph vessels of the lower limb, infraumbilical abdominal wall, genital system, urologic system and the inferior mesenteric 60 Observe in this illustration the drainage of the lower abdominal wall towards the corresponding inguinal lymph node chain.
According to Casley-Smith the main structural causes of lymphedema are as follows: a - narrow or abnormally scanty tissue channels; b - abnormally scanty initial lymphatics; 31 c - incompetence if the initial valve system; d - separation of the fixation bands of the lymphatics; e - hypoplasia and obstruction of the collectors. Related to functional causes, are lack of variation of tissue pressure, decreasing the flow in tissue channels and reduction of the pumping mechanism in the initial lymphatics.
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. 40 The last illustration suggests that the direction of drainage should always be in the direction of the flow. Circular movements may go against the direction of the flow, thereby forcing the valves of the lymphatic vessels.