Lymphedema

By Janet Wolfson PT, CLWT, CWS, CLT-LANA With increased awareness of the impact of the lymphatic system on all other systems of the body, there are now multitudes of research studies on lymphedema and thus new approaches and treatments by the medical profession. These include medications, prevention, detection, surgery, and regeneration. Despite cursory education on the lymphatics in medical school, research in the United States and elsewhere has managed to progress treatment.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Lymphedema can be defined as swelling of one or more limbs which may also include a portion of the corresponding trunk. Lymphedema can also affect the breast, head, neck or genitalia. It occurs when fluid and other components such as protein accumulate in the tissue spaces as a result of a disparity between the creation of interstitial fluid and its transport or movement. It may be caused by damage to the lymphatic system (i.e., as a result of cancer treatment) or as the result of a congenital malformation of the lymphatic system. It is a chronic condition with no cure, but it can be managed if diagnosed early on.

By the WoundSource Editors Lymphedema is edema—swelling of tissues caused by fluid in the intracellular space—that is caused by dysfunction or disruption of the lymphatic system. The lymphatic system uses lymphatic vessels to absorb, transfer, and filter fluids from peripheral intracellular spaces and return these fluids to general circulation. When there is an obstruction or a structural change to the lymphatic system, typically experienced in response to surgical or neoplastic changes, the transfer of extracellular fluids from the periphery is inhibited, resulting in localized edema distal to the site of the structural deficiency.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA Long ago, in a Physical Therapy Department far away, I met my first lymphedema patient, but did not know that was the cause of her recurring wounds. Into the next decade, I treated more patients with chronic swelling in their legs and we put something called Unna boots on them. But the boots did not work for everybody. By the end of the decade, there were layered compression wraps and I had started to see courses for therapists in manual lymphatic drainage. Hmmm, curious…

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA I know we have all had those patients with diagnoses that impair their wounds forming granulation tissue to fill wound depth. Perhaps there are comorbidities such as diabetes, peripheral artery disease or malnutrition. Skin flaps, cellular and/or tissue-based products for wounds, and hyperbaric oxygen therapy are alternatives, but not every patient can tolerate surgery or a hyperbaric chamber, has a shallow enough wound or enough arterial supply to make these other options successful.

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA As the 116th Congress ruffles its feathers and dusts out the corners, it's another chance for the Lymphedema Treatment Act (LTA) to become law. The Senate bill was given bill number S 518, whereas the House bill is pending. In the previous Congress, the bill had a super majority support in both Senate and House. One can only speculate what else might have consumed their time.

Brandy Mckeown, OTR/L, CLT-LANA, CLWT In this interview, WoundCon speaker Brandy Mckeown shares her insights on new innovations and practical knowledge regarding the treatment of lymphedema and lipedema.

By Janet Wolfson PT, CLWT, CWS, CLT-LANA Introduction, History, and Practitioner Background Manual lymphatic drainage (MLD) was developed by Emil and Estrid Vodder in the 1930s. They dedicated their lives to the study of lymphatic anatomy and physiology. Since then, others have modified the original techniques, including Foeldi, Leduc, Casley-Smith, and Bjork. They all involve manual contact with the client, deep diaphragmatic breathing, stimulation of the lymph nodes, and movement of fluid from proximal and then distal areas. The manual contacts are slow, gentle, and rhythmic. Practitioners are typically occupational or physical therapists, physical and occupational therapy assistants, nurses, massage therapists, and physicians. Many practitioners, after a required 135-hour training program, complete the Lymphedema Association of North America (LANA) certification exam.