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. Premier Heart and Vein Care is the only practice in the region providing comprehensive wound and lymphedema care related to venous insufficiency.
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.
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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
- Utilization of both CircAid and Flexitouch systems to help manage swelling
What causes lymphedema?
Lymphedema is commonly caused by either damage to your lymphatic system or blockage in the system or chronic venous insufficiency. There are two types of lymphedema:
Secondary lymphedema — This form is caused by another condition or disease that damages your lymph nodes or lymph vessels. These are some of those causes:
- Cancer or radiation treatment for cancer
- Infection in the lymph nodes
- Lymph node removal
- Injury to the lymph nodes
- Chronic venous insufficiency
Primary lymphedema — This form is much less common. It is a genetic problem where the person’s lymph nodes or vessels are missing or are poorly developed.
What are the stages of lymphedema?
There are four stages to this condition:
- Stage 0 — Also called latent lymphedema, there are no visible changes, but the lymph transport is impaired. Patients may have tightness in the skin or heaviness.
- Stage 1 — This is mild lymphedema. It includes mild swelling that will begin in the furthest part of the limb, such as the hand or foot, and slowly moves up the limb. Gravity causes this pooling during the day, and it may disappear at night when the limbs are raised.
- Stage 2 — Moderate lymphedema causes the skin to acquire a spongy appearance and it pits less than in Stage 1 because the skin is gradually thickening due to fibrosis. Fatty tissue will likely be accumulating below the skin due to inflammation from the lymph fluid building in the tissues.
- Stage 3 — Also known as severe lymphedema, the skin becomes very hard and scaly and enlarges significantly. The skin can begin leaking, a condition known as lymphorrhea through breaks in the skin. Skin folds become a problem and infections develop in them. The limbs become very heavy and impact movement.
What are the signs a person has lymphedema?
- Swelling of part or all of your leg or arm, including the digits.
- A feeling of heaviness or tightness
- Restricted range of motion
- Aching or discomfort
- Recurring infections
- Hardening and thickening of the skin (fibrosis)
How does lymphedema affect wound healing?
The presence of lymphedema can greatly increase the risk of wounds forming on the feet and legs or the arms. If lymph fluid drains from wounds it can increase the risk of infection and work to delay healing.
The edema created by the lymphedema impairs blood flow and decreases the ability to deliver or remove nutrients such as oxygen and carbon dioxide. The increase of fluids can lead to bacterial colonization and trap growth factors, peptides, and proteins at the site. All contribute to delayed wound healing and increase the odds of developing an infection in the wound. The associated venous insufficiency needs to be treated first and then the lymphedema can be addressed. Isolated lymphatic massage only transiently helps mobilize the fluid; definitive treatment is needed to better control the condition.
Can a wound cause lymphedema to occur?
No. Lymphedema is caused by damage to the patient’s lymphatic system, often from radiation treatment, prior surgery, or injury to the lymph nodes. This is a problem because the lymph nodes act as filters and contain cells that fight infection and cancer.
Wounds don’t create these problems. But the increased swelling and inability of the body to deliver oxygen and clear carbon dioxide, along with excess proteins and other elements, makes even the slightest injury to the skin cause for concern. These wounds, no matter how small or large, now are more susceptible to infection, and they could have difficulty healing.
Can I get lymphedema again in the future?
There is no cure for lymphedema. Dr. Stevens focuses treatment on reducing the swelling and preventing complications. Whether your lymphedema worsens again is partially up to you. You need to take care of the affected limb through cleaning the skin daily and checking for any signs of cracks and cuts. Apply lotion to dry skin. Compression devices, radiofrequency ablation, and sclerotherapy are used to help manage the swelling as well.
It is also important to pay attention to how you care for your whole body. Eat a diet rich in fruits and vegetables. Exercise every day, if possible. Lower your stress levels and improve your sleep. A healthier body is the best way to encourage healing and reduce the impact of your lymphedema.