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Lymphedema

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.

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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.

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Compression

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.

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Lymphatic System

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.

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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.

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Chronic Wounds

By the WoundSource Editors

The wound healing cascade is a complex process that follows a strict sequence of molecular events. The complex series of events depend on one another and must take place in a timely and orderly fashion within the body’s natural host processes. The phases of acute wound healing, in order, are hemostasis, inflammatory, proliferative, and maturation. If the cascade of events is interrupted, the acute wound status then develops into a non-healing or chronic status. Wound stalling occurs in the inflammatory and proliferative stages of healing. In chronic wounds, there appears to be an overproduction of matrix molecules resulting from underlying cellular dysfunction and dysregulation. Non-viable or devitalized tissue lengthens the inflammatory phase of healing and increases risk of infection.

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Patient Outcomes

By the WoundSource Editors

Wound chronicity is a major concern, and removing barriers with each stage of healing is paramount. Debridement may occur naturally by the body’s own ability to slough off dead tissue; however, often this tissue needs to be removed medically. The goal of wound debridement is to provide consistent wound bed preparation along with good healing outcomes. Removing non-viable tissue and foreign material is the first goal of debridement. Non-viable tissue not only inhibits the development of healthy new tissue but also increases the risk of infection. Non-viable tissue includes slough and eschar, which create the perfect recipe for bacterial growth and infection. Viable tissue is granulation and epithelial tissue, which is beneficial to normal healing. Wounds that present devitalized tissue and/or biofilm warrant one or more of the debridement methods to promote healing. Since 2006, debridement has been found to be advantageous in managing complex wounds.

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Debridement Methods

By the WoundSource Editors

A wound specialist’s job is to outline the options available for treatment. It is the patient’s job to choose a treatment option. Patients do not even have to select the best option. They must choose an option that works for them given their unique circumstances having a wound. When it comes to selecting debridement methods there are several options to choose from. This article will provide an overview of the most common debridement methods.

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Debridement

By the WoundSource Editors

In chronic wounds, debridement can be used to remove dead and necrotic tissue or to remove foreign material. Debridement has repeatedly been shown to expedite healing and is recognized as a critical element in wound care. There are several methods of debridement, some of which may or may not be the best option, depending on the health care setting, so practitioners should follow their individual state licensure boards’ professional scope and practice and the facilities’ policies when considering debridement.

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by the WoundSource Editors

Autolytic debridement: A method of debridement that uses the body’s own enzymes and the moisture trapped beneath the dressing to liquefy non-viable tissue. Although it is the safest method, it is also very slow and therefore not the best option for wounds with large amounts of necrotic tissue.

Biofilm: A complex microbial community containing bacteria and fungi. The microorganisms synthesize and secrete a protective matrix that attaches the biofilm firmly to a living or non-living surface. The biofilm contributes to underlying wound infection, chronic inflammation, and delay in healing, and it is present in 60% of chronic wounds and 6% of acute wounds.

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