Design an exercise program for a patient with lymphedema

The capillaries merge and become precollectors, which have a larger diameter and therefore a lower pressure, thus facilitating movement of the fluid from the capillary to the precollector. The precollectors also have the overlapping endothelial anatomy that allows them to absorb interstitial fluid, and they have both a limited number of valves and a limited smooth muscle structure that allows them to initiate transportation of the collected fluids.

All of the precollectors merge to become larger diameter vessels, termed collectors. The collectors first bring the lymph fluid to the lymph nodes and then carry the remaining fluid to the larger lymphatic trunks. The anatomical structure of the collectors is similar to the construction of the veins in that they have three distinct layers (intima, media, and adventitia). They have welldefined valves that permit flow to go in only one direction—toward the heart. Within the lymph collector, the vessel segment between two valves is termed the lymphangion (FIGURE 55). Each lymphangion has an autonomicdriven resting contraction rate of approximately 10–12 contractions per minute.1 This is further discussed under physiology. The superficial lymphatic collectors are located in the subcutaneous fatty hypodermis and they follow a direct route toward the regional lymph nodes. The deep lymphatic collectors follow the pathway of larger blood vessels. Lymph collectors drain lymph fluid from specific areas of the body, creating lymphatic “territories” that drain to specific regional lymph nodes. These lymphatic territories are defined by lymphatic watersheds that tend to delineate the body into specific collection and drainage patterns (FIGURE 56). Although there is some crossconnection between the territories via the watersheds, most of the fluid flows directly to its own regional lymph nodes. If there is fluid overload in one area, some of the fluid can be diverted to another region via the watershed connections. Caritas Bianchi College of Careers Access Provided by:

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The removal of any regional lymph nodes results in a reduced ability for the immune system to respond to foreign pathogens and an increased risk of developing infection.

FIGURE 55

L y m p h a n g i o n The lymph vessels containing lymphangions are adjacent to the muscle; thus, when the muscle contracts the lymph flow is increased. Valves and smooth muscle in the angion promote directional flow of the fluid and prevent reflux, much like the valves in veins.