Lymphedema and Wound Management: Evaluating Product Technologies

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compression therapy for lymphedema

By Janet Wolfson PT, CLWT, CWS, CLT-LANA

The intersection of wounds and lymphedema has been on my mind this week as challenging patients and a new reduction garment cross my dual specialty life. One patient with chronic swelling with weeping for more than a decade, another referred a few days before discharge who will need a few weeks Complex Lymphatic Therapy and a reduction garment that he and his spouse can manage for showering. Still another experiencing light weeping, chronic edema and is post-heart failure. They are all inpatient rehab clients attempting to improve their mobility and self care enough to go home. So, the wish list for reduction compression and absorbent wound care products needs to fit some special needs.

Compression Therapy for Lymphedema Management

A range of compression from 20 to 50mmHg to treat a variety of patients so that comorbidities can be accommodated would simplify inventory and choices. This wonder garment needs to be modifiable, so that as the volume of the limb reduces, the garment can be adjusted or modified. This will save the patient and facility money and the environment benefits as well. Continuity of care is improved as the patient can be discharged with this garment too. Easy on and off is helpful as well, so that the patient/family can be learning to manage the garment while they concentrate on self care goals with therapy and nursing staff. Patients whose volume can fluctuate (heart, kidney and liver failure) would benefit from a garment that will accommodate this. These patients have enough mobility challenges, so a garment that is not bulky and throwing their balance off would be desired. And if it is not too much to ask, a thigh component, please?

I have encountered a few candidates to address some of these accommodations accommodations for lymphedema clients. A reduction kit garment is available from Circaid®/MediUSA that meets all the above with a few more highlights as well. It also has a component to support lobules. JOBST® FarrowWrap® (BSN Medical, Inc.) offers two categories of compression and silver (think antimicrobial) liners. Amerx Health Care Corp. has come up with a new garment for lower leg only that uses bungee cords and a zipper to easily don: Extremit-Ease™. Gradient compression in the 30-50mmHg range is adjusted with tension in the bungees. Sigvaris offers a latex-free garment of Breath-O-Prene® fabric straps that can be lengthened with extenders. It is available for knee high and thigh garments. Need to go higher? BSN Medical, Sigvaris and Solaris all offer garments for treating lymphedema in both genders. Please note that this list of compression reduction garments is not exhaustive and only represents treatment options that I have used in my practice; research and compare the compression options available to you in your own clinical practice to determine the garments to best meet the individual needs of your clients.

Absorbent Dressings and Moisture Management

The wish list is highlighted with the key word of "absorbent." Not only must the wound dressing absorb large amounts of lymphorrhea, but also lock it in to extend wear time and prevent maceration. Oh, and it must do so under the compression wrap. So, if you were to attempt to wring out the bandage, the fluid would stay locked in. Antimicrobial and MMP management qualities built in would simplify application as well.

My research has led me to several products to meet these needs, which can be found in WoundSource. Sizes vary: Eclypse® (Advancis Medical USA) makes a 24"x16" absorbent locking system for that looks promising for limbs with large weeping areas. A foot specialty dressing is available as well. Enluxtra™ (OSNovative Systems, Inc.) has a fluid-locking bandage and is available in a roll product that can handle circumferential wounds. Drawtex® (SteadMed Medical, LLC) , a high tech wicking and electrostatic dressing, removes debris including bacteria and MMPs. It comes in a multitude of sizes from 8"x8" to 8"x39" rolls. Dive in at WoundSource and view the listings for absorptive wound care dressings, there is a smorgasbord of options for high exudating wounds. This is a good place to conduct comparative research in selecting dressing options to address specific requirements in managing your clients' lymphedema.

So technology and innovation are thriving in the lymphedema and wound care markets. Gone are the days of only gauze, but you may get a patient or two appearing in clinic with a diaper wrapped around their leg. Because lymphedema garments aren.t covered by Medicare and most insurances, these folks are still looking for cheap absorbency. Which brings up one of my favorite topics: The Lymphedema Treatment Act is gaining support in both houses of Congress. If you aren't sure that your representative or Senator hasn't signaled their support yet, you can find out and send your thoughts by following this link: lymphedematreatmentact.org

About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

I appreciate your insights. More attention needs to be given to this often neglected patient group. I too have struggled with finding appropriate commercial products to address my patients' compression needs. The displays at the 2017 SAWC/WHS and WOCN conference exhibit halls were encouraging, however. Many manufacturers are beginning to produce innovative new compression garments. I was able to find several velcro-based adjustable compression systems that were relatively simple for elderly patients with venous hypertension to don and doff. One patient in particular was able to begin with a lower level of compression and work her way up to a more optimal level using a system with markings to indicate how much pressure she was applying.

Choosing dressings to go under such systems is critical to success as well. I agree that the exudate should be locked into the dressing to prevent maceration. However, most of the specialty absorptives have hard edges, which can lead to significant skin damage from pressure points.[1] Fortunately, dressings are available that have a very soft edge and high absorbency AND lock in fluid in the form of a gel using baby diaper technology: polymeric membrane dressings (brand name: PolyMem Max). These dressings also subdue and focus inflammation, addressing an important underlying cause of venous ulcers.[2] Completely independent authors have presented twenty-seven posters representing well over one hundred venous leg ulcer patients at major conferences to demonstrate the safe and highly effective use of polymeric membrane dressings for this challenging wound type.[3]

Linda Benskin, PhD, RN, SRN (Ghana), CWCN
Independent Nurse Researcher for rural areas of tropical developing countries and
Clinical Research and Education Liaison, & Charity Liaison, for Ferris Mfg. Corp.

References:
1. Al-Muhairi M, Phillips T. Surgical Pearl: A Wound Dressing Tip for Venous Ulcers. Wounds. 2006;18(6):158-161.
2. Cutting KF, Vowden P, Wiegand C. Wound inflammation and the role of a multifunctional polymeric dressing. Wounds International Journal. 2015;6(2):41–6.
3. Benskin LL. Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples. Ostomy Wound Manage. 2016 Jun;62(6):42–50.

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