[Physical lymph drainage and therapy of edema in chronic venous insufficiency].

In the treatment of protein-rich edema surgical venous insufficiency, manual maximization of lymphatic drainage, manual maximization of the edema apophoresis according to Asdonk (1, 2, 3) and Bartetzko (5) is an effective therapy when it is appropriately combined with the physiotherapy, medication and surgical measures usual in phlebology. The late and incomplete healings as well as recurrent lesions can frequently be improved or controlled more effectively than is possible without these techniques. The treatment takes place in three stages. First of all, the lymph vasomotor activity is stimulated in the lymphatic drainage area proximal to the edema. Afterwards, the excess of fluid and protein in the edema area is eliminated as far as possible with the hand grip system of Bartetzko. Finally, the tissue altering and painful secondary lesions are treated with especially careful tissue deformations. Besides medication, compression bandages and movement therapy are to be applied simultaneously beforehand or afterwards, or obliteration or surgery are to be performed.