Lymphedema Management

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 Janet Wolfson, PT, CLWT, CWS, CLT-LANA If you read my last blog on therapeutic interventions to stimulate wound healing, then you may recall the asset that a lymphedema trained therapist can be to your wound care department. A recent patient at the inpatient rehab facility where I am currently the Wound Care Coordinator illustrates this wonderfully.

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 Reflecting back on "In the Trenches With Lymphedema," WoundSource's June Practice Accelerator webinar, many people sent in questions. I have addressed some regarding compression use here.

By Alton R. Johnson Jr, DPM Four weeks ago, I was granted the privilege to treat a patient with type 2 diabetes with neuropathy who presented to the wound care center after developing a full-thickness pressure ulceration on the lateral aspect of her right leg as a result of an ill-fitted brace used four weeks earlier. The first clinical feature I noticed about the patient's lower extremity compared with the previous encounter was marked increased pitting edema. As a sequela of the lack of compression, the patient's lower extremity edema had increased, causing the wound to break down further in comparison with our last encounter with her. I first asked the patient why she discontinued the multipurpose tubular bandage that was dispensed and applied to her right extremity during the last visit. Her immediate response was that the home health aide had disposed of it by mistake; however, the patient stated that the aide used an available non-compressive stockinette instead.

By the WoundSource Editors Edema is the abnormalaccumulation of excess fluid within tissue. The swelling associated with edema can be localized to a small area following an acute injury, it can affect an entire limb or a specific organ, or it can be generalized throughout the entire body. Edema is not a disease, but rather a symptom that can indicate general health status, side effects of medications, or serious underlying medical conditions.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA It is hard to read a newspaper (my preferred news source) or an online news site without discovering false information. I recently read an NPR article about how to vet news yourself and how to recognize this.1 The vulnerability I felt made me think about protecting my decisions from this reporting and even more, how I can help my patients weed out fake reports.

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…