Wound Care & Lymphedema Treatment
Lymphedema results from insufficient drainage of lymphatic fluid in an extremity. The resultant pooling of lymphatic fluid causes the extremity to swell, which can lead to infection or ulceration. Lymphedema may be caused by any of several disease processes, or may be a congenital condition. It is also possible for lymphedema and venous disorders to exist in the same patient. When lymphedema is complicated by poor circulation, there is likely to be great difficulty in healing the patient's wounds.
Venous Insufficiency and Lymphedema
Venous insufficiency can also lead to swelling of extremities, particularly the legs, when blood pools because of weakened vein walls and dysfunctional valves. It is important that such swelling be correctly diagnosed, because leg swelling can be the result of a number of different causes, including heart failure and inflammation from traumatic injury.
It is also essential to differentiate vascular and lymphatic issues since they may present with similar symptoms.
At times, untreated chronic venous insufficiency can lead to secondary lymphedema, and either condition may be complicated by excessive weight. When patients have either problem, or a combination of vascular and lymphatic issues, they often suffer from slow-healing wounds.
Wound Care in Patients with Lymphedema
There are several possible treatments for wounds in patients whose vascular and/or lymphatic function is impaired. While there are a variety of medical and surgical curative treatments for venous insufficiency, chronic lymphedema is incurable. There are, however, several ways of treating lymphedema to keep it from worsening. They include compression, with support garments or devices, elevation of the affected limb and correcting the underlying cause such as venous insufficiency. Such treatments are important because untreated lymphedema can result in decreased function and mobility of the affected area, and may lead to serious infection and swelling. To avoid infection, patients with lymphedema need to be especially mindful of hygiene, and avoid situations that might result in injuries.
Once a wound occurs in a patient with lymphedema and possible vascular concerns, treatment includes the following:
- Aggressive administration of antibiotics to avoid cellulitis
- Debridement to remove necrotic tissue
- Gentle scrubbing and irrigation
- Compressive & non adhesive dressings to help with wound healing & avoid deep venous thrombosis
- Massage therapy to help fluid drain
- Exercise involving gentle muscle contraction.
- Applying either radiofrequency ablation or sclerotherapy to address the underlying venous insufficiency and venous hypertension
- Application of Apligraf as needed to help with venous ulcer healing