Phlebolymphedema is a swelling of mixed etiology that occurs because the lymphatic system is unable to adequately drain the interstitial fluid that accumulates in severe chronic venous hypertension. A host of contributing factors such as systemic disease (eg, congestive heart failure, cirrhosis, or nephropathy) can increase demand on the lymphatic system; insufficiency of the venous or lymphatic system (or both), in combination with possible systemic contributors, leads to the accumulation of interstitial protein-rich fluid in the interstitial space and subsequent phlebolymphedema.1
The circulatory and lymphatic systems in the human body maintain a delicate balance. If the venous system is damaged, it usually affects the lymphatic vessel system. It is not unusual for the legs of affected patients to be swollen in the evening. Lower leg volume can increase up to 100 mL after a long working day or up to 200 mL after a long flight during which the legs remain stationary. Edema that does not resolve spontaneously within a few hours or after a walk is considered pathological.
Bilateral and marked edema with few symptoms is mostly caused by systemic circulatory dysfunction involving the heart, kidneys, and/or liver. Venous edema is almost always associated with symptoms and/or clinical signs that include dilated superficial veins, varicose veins, and skin changes. Chronic venous edema is only partially reversible and soon becomes hard, which is mainly confirmed on palpation. All skin structures are affected, and the lower leg can take on the appearance of an upside-down champagne bottle. Secondary lymphedema may develop, accompanied by thickening of skin folds, hyperkeratosis, and papillomatosis.2
Drawtex Hydroconductive Wound Dressing (SteadMed Medical, LLC, Fort Worth, TX) features a combination of 3 physical actions on the wound bed that actively draw exudate, bacteria, and deleterious chemicals out of the wound.3 Capillary action draws water and fluids into porous materials such as textiles against gravity, hydroconductive action allows water to be drawn in both a vertical and horizontal direction as governed by Darcy’s Law (the ability of fluid to move through a porous media), and electrostatic action facilitates attraction or repulsion between electrically charged bodies. The hydroconductive mechanism is much like the mechanism by which a tree transfers water from its roots to its leaves. The electrostatic action (the strongest action) that draws bacteria and deleterious chemicals from the wound tissue (not just the wound surface) into the Drawtex dressing causes the surface of the dressing closest to the wound to have a positive electrical charge. Bacterial cell walls and the chemicals in cytokines have a negative charge. These charge differences are responsible for drawing the substances from the tissue into the dressings.3 Drawtex, with its patented LevaFiber technology, allows the drawing action to be both vertical and horizontal so the exudate, bacteria, and deleterious cytokines are drawn to the opposite dressing surface and dispersed. Therefore, Drawtex does not become supersaturated and or leak exudate. No other dressing has this combination of actions.
In addition, research has demonstrated that the bacterial level and the matrix metalloproteinase (MMP) level in the wound tissue are decreased and the bacterial level and the MMP levels are increased in the Drawtex dressings4,5; as a result, nutrients to support biofilm production are reduced,6 which has been shown to improve perfusion.7
Recently, Drawtex was presented in a new iteration, Drawtex Edema Wrap, a more pliable and functional dressing that can reduce edema, manage fluid, and support enhanced wound management in legs. Two (2) cases of phlebolymphedema treated with the Drawtex Edema Wrap are described.