Cath Lab Digest

Global awareness of the “hidden epidemic”¹ of lymphedema and chronic wounds was heralded by a wake-up call from the World Alliance of Wound and Lymphedema Care² (WAWLC). Worldwide, one person in 30 is estimated to suffer from lymphedema,¹ often with associated chronic wounds. Lymphedema results from conditions as diverse as filariasis (23 million cases in India alone) or surgery involving lymphatic tissue (20% to 40% incidence following groin surgery).¹ Among persons older than 60 years, 1% to 3% are afflicted with chronic venous ulcers and edema resulting from venous insufficiency.³ Another 15% of 385 million people globally with diabetes⁴ are likely to develop at least one diabetic foot ulcer in their lifetime.¹ The magnitude of the global epidemic of other chronic wounds such as pressure ulcer ulcers and infected surgical or trauma wounds is only beginning to be appreciated and may be equally as large.

For many conditions, lymphedema and wounds have mutual or related causes. Getting the diagnosis right, addressing the cause early, and managing the wound well can save limbs and lives. Historically, this doesn’t always happen because the pool of professional knowledge has been only isolated puddles. For the first time, professional knowledge and local knowledge are being integrated in a coordinated effort across diseases, professions, services, systems, and global nongovernmental volunteer organizations to address problems of wounds and lymphedema that have plagued mankind since the dawn of time.

Interest was sparked in Accra, Ghana in July 2007 at the Lymphatic Filariasis Workshop on Disability Prevention for Field Managers, sponsored by Handicap International, where researchers, managers, and clinicians reported on lessons learned from their respective programs. Participants were encouraged by the World Health Organization (WHO)/AFRO Program Development Officer, Dr. Likezo Mubila, to explore strategies for the integration of care for a number of diseases to avoid duplication, maximize resources, and build synergy among stakeholders and governments. Wound and lymphedema management emerged as a common element of care that crossed all of these diseases and subsequently became the focus for training initiatives.

In September 2007, the concept of implementing an integrated approach to wound and lymphedema care was presented by a group of international stakeholders to relevant WHO staff in Geneva. The WHO challenged participants to develop integrated disease-specific guidelines and corresponding training curricula adapted for different levels of healthcare systems within worldwide settings with limited resources. The first step toward accomplishing this goal has just been published by the WHO in the form of a 122-page volume, Wound and Lymphedema Management. The text was edited by John Macdonald and Mary Jo Geyer, with chapters by distinguished authors from around the world: T. J. Ryan, T. A. Treadwell, W.J. Ennis, R. G. Sibbald, H. L. Orsted, P. M. Coutts, D. H. Keast, L. L. Bolton, and R. S. Kirsner. Many of these authors share their hands-on experience managing chronic wounds and lymphedema in remote settings with limited resources. Permission to copy or translate this volume may be obtained from the WHO Press at permissions@WHO.Int. Hard copies can be obtained by contacting John Macdonald (trapparmac@aol.com).