STRIDE, which stands for shape, texture, refill, issues, dosage, and etiology, provides a comprehensive guide for selecting compression garments and wraps. It is a resource for new clinicians and an excellent review for advanced practitioners.
By Janet Wolfson, PT, CLWT, CWS, CLT-LANA
At the beginning of September, I attended the National Lymphedema Network International Conference in Dallas, TX. As with most conferences it was chock-full of new research, meet-ups with former colleagues, vendors with wonderful new and upgraded products, and clinical topics to improve direct care. Continue reading for some highlights that can improve care in your wound clinic for venous disease patients, as well as lymphedema and lipedema patients. Preoperative awareness of lymphedema was also highlighted at the conference.
Stanley Rockson, MD (Director, Center for Lymphatic and Venous Disorders at Stanford University School of Medicine) was the keynote speaker of the opening ceremony. He bathed our brains with wonderful new research and discoveries as he told us that "Lymphedema was No Longer the Forgotten Disease of the No Longer Forgotten Circulation." He went on to amaze us with new research revealing that a new medication, Ubenimex, is entering final human trails to treat secondary lymphedema (Clinical Trials.gov identifier NCT02700529). The first!
- A scaffold for lymphatic vessel growth has been developed. It is made of biologic materials and acts as a "bio bridge". Studies showed rapid and clear growth of new collectors and would be a natural to combine with a lymph node transfer.
- Reimbursement for bioimpedance testing is available to detect extra cellular fluid. Surgeons are encouraged to prescribe this easy, noninvasive and quick procedure prior to surgery. A course of complex lymphatic therapy (CLT) prior to surgery and use of compression garments post-op can prevent dehiscence.
- Biomarkers: Six proteins in the blood can now be measured to diagnose lymphedema. Suspect your client has lymphedema? This is an easy way to diagnose!
- VEGF-C, a lymphatic growth factor, when given daily, improved lymphatic drainage after surgery.
- Liposuction for lymphedema can be successful, but post-op compression garments are vital. The lymphedema should be reduced via CLT preoperatively.
- Suction-assisted protein lipectomy can be effective in both primary and secondary lymphedema, however primary does not do as well. The procedure has documented decreased incidence in cellulitis. Obesity should be addressed first and a course of CLT completed as well.
- Lymphatic venous anastomosis and lymph node transfers are proving effective in treating early stages of lymphedema. Later stages have a fat buildup that makes other procedures a better choice.
So after four days of listening and querying the experts, I came away with some tidbits for my In-patient Rehab Wound Care practice. Communicating with our orthopedic surgery referral sources about preoperative lymphedema diagnosing and CLT if positive could lead to better outcomes in function and reduced rates of infection and dehiscence. This diagnosing can be done objectively through noninvasive procedures or blood tests (If available!).
The only defeating note was that medical school lymphatic education still amounts to less than an hour. Progress can really take off if our medical specialists are aware of the impact of the lymphatic system on their patients' health.
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.