Lymphedema

by Tia Gray, PTA, CLT, CWT and Donald Thomas, PT, DPT, CLT-LANA, CWT

As lymphedema and wound care therapists at Penn Therapy & Fitness, we often see scenarios like those in the cases described in our abstract presented as a poster at the recent Symposium on Advanced Wound Care. Conditions such as lymphedema, chronic venous insufficiency, and phlebolymphedema that manifest in patients with wounds can lead to catastrophic and life-threatening skin breakdown (degradation). Complications of infections associated with lymphedema include cellulitis, lymphangitis, lymphadenitis, and ulcerations where protein-rich fluid provides a perfect medium for microbial growth.

By the WoundSource Editorsr

Lymphedema is defined as “an accumulation of lymph fluid in the soft tissues, most frequently in the arms or legs.” It impacts approximately one in every six patients in the United States who are undergoing solid tumor treatment. Lymphedema has become more prevalent with the increase in survival rates resulting from the emergence of more effective oncologic therapies; however, there remains no definitive cure for lymphedema.

By the WoundSource Editors

As health care professionals, we see patients with lymphedema every day. However, do we know how to manage lymphedema? Are we confident in successful management of lymphedema? The answer, many times, is no. The lymphatic system goes hand in hand with the integumentary and vascular systems. Certified Lymphedema Specialists play a critical role in lymphedema and wound care expertise, but providers must also learn to approach the complexity of lymphedema with or without wounds with foundational knowledge and skills to provide the best outcome. Underlying medical conditions must also be properly managed. Hospitals, wound care clinics, and private practices should develop a comprehensive lymphedema management program.

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 the WoundSource Editors

The lymphatic system is an incredibly complex network of tissues and organs. Together, this network regulates fluid balance, transports fatty acids from the gastrointestinal tract, and contributes to the immune system. Dysfunction in the lymphatic system can lead to lymphedema and tumor development. Although it is common to treat wounds and lymphatic dysfunction as separate conditions, there can be many benefits in viewing these conditions as interrelated.

By the WoundSource Editors

Cellulitis: A common bacterial skin infection that appears as a swollen, red area of skin that feels hot and tender; also known as lymphangitis. Treatment should begin promptly to avoid having the infection spread rapidly and become life-threatening.

Complete decongestive therapy (CDT): The system of lymphedema treatment that includes manual lymph drainage (MLD), compression techniques, decongestive exercise, and self-care training.

Congenital lymphedema: A form of primary lymphedema that is present from birth; also known as Milroy's disease or Nonne-Milroy disease.

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.

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

Last spring, I encountered that specific type of patient we sometimes meet, the one who has been through the chronic wound care revolving door so many times that he or she sets out on his or her own path and refuses any byways diverting from it.

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

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.