Lymphedema: Skin and Wound Care in an Aging Population
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Chronic venous insufficiency (CVI) is a common cause of edema and ulceration of the skin. Lymphatic abnormalities exist in patients with CVI.4,5 Lymphedema is always present in advanced stages of CVI, and theories regarding the pathogenesis of skin ulceration in patients with this disorder are numerous.4,5 Skin grafts are unlikely to work on an edematous area. MLD, a gentle manual treatment that improves the activity of the lymph vessels and re-routes the lymph flow around the blocked areas into more centrally located lymph vessels that drain into the venous system, can reduce the pain, fibrosis, and postoperative morbidity in postsurgical cases.6 The bottom line is that ulcerations of the skin are not likely to heal in the presence of edema for whatever reason. Again, skin care, wound care, and edema must be addressed at the same time. While the authors' emphasis is on lymphedema, skin care always has been an important part of lymphedema treatment.
Over the years, the authors have tried to emphasize the need for skin care in their patients. With the aging population, low pH moisturizing lotions and standard wound care methods are proving to be inadequate in patients whose skin has broken down or has that potential; hence, preventing the use of standard lymphedema treatment in many patients.
Recently, soft silicone technology products of various kinds (eg, Tendra, Mölnlycke Health Care, Newtown, Pa.) have been used according to patients' needs, type of wound, and amount of skin drainage Wound adherence has not been a problem and these products are easy to use. They have enabled clinicians to perform CDT, a comprehensive form of treatment for lymphedema involving physical techniques, compression wrapping, and patient education, as well as MLD, wrapping over the skin dressings. This has enabled lymphedema treatment; thereby, promoting wound healing while treating skin ulcerations. Silicone-based products also have been used in jeopardized skin as a preventive measure in conjunction with the usual wrappings and treatment for lymphedema. Thus far, this appears to be an effective approach.
Although patient numbers are small at the authors' facility and their experience may be somewhat anecdotal, lymphedema treatment in conjunction with soft silicone technology appears to be a workable combination and merits further investigation. - OWM
The authors are grateful to Anita King and Leora Krupnick for their invaluable assistance in preparing this article, as well as Joachim Luther and The Academy of Lymphatic Studies. They especially thank Robert Lerner, MD, who has been and continues to be an inspiration to all.
Addressing the Pain is made possible through the support of Molnlycke Health Care, Newtown, Pa.
1. King MJ. Lymphedema - the role of the physician. Contact the author.
2. King MJ, DeFalco E. Multiple radio tapes and articles. Contact the author.
3. Foldi M, Foldi E, Clodius. The lymphedema chaos. Ann Plast Surg. 1989;22:505.
4. Tehrani H. International Varicose Vein Congress. Miami Vein Center. Key Biscayne, Fla. September 21, 2003.
5. Hartmann M. CVI. In: Weissleder, Schuchardt. Lymphedema - Diagnosis and Therapy. Viavital Verlag GmbH; 2001:266-282
6. Cass LA, De Poli P. Manual Lymphatic Drainage Therapy: An Integral Component of Post-Operative Care in Plastic Surgery Patients. Abstract lecture. Northwestern University of Medical School.