Lymphedema Management

By: Marta Ostler, PT, CWS, CLT, DAPWCA, and Janet Wolfson, PT, CLWT, CWS, CLT-LANA

M. Mark Melin, MD, FACS, RPVI, FACCWS

Understanding that February is venous leg ulcer (VLU) month, we would be remiss to exclude a consideration of the critically important role played by the lymphatic system. As such, I want to highlight the work of Dr. Tom O'Donnell in a recent editorial written on this subject.

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

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 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.