Textbook of Chronic Wound Care: Chapter 13 Lymphedema

Course overview

KEY CONCEPTS Lymphedema is a vascular disorder that is either due to congenital malformations of the lymphatic system (primary etiology) or related to an insult or injury to the lymphatic system (secondary etiology) such as surgery, trauma, radiation, malignancies, or infections. Secondary lymphedema is more prevalent than primary lymphedema. On a global scale, the leading cause of lymphedema in the world is due to lymphatic filariasis, a parasitic form of lymphedema spread through mosquitoes. Cellulitis is common in patients with lymphedema and may require recurrent hospitalizations. A positive Stemmers sign is a simple clinical finding that yields a definitive diagnosis of lymphedema. Lymphoscintigraphy is accurate for detecting abnormalities of the lymphatic sys- tem in the extremities and shows slow or absent lymph flow and areas of reflux (backflow). Complete decongestive therapy (CDT) is considered the standard of care for lymphedema management. Surgery for lymphedema is not curative but may help manage severe cases. Multilayered lymphedema bandaging (MLLB) is composed of multiple layers of short-stretch bandages, along with hygienic lining and padding materials, to cre- ate graduated compression with high containment. All patients need to be transitioned into compression garments for lifelong maintenance management of lymphedema. Intermittent pneumatic compression (IPC) devices, or lymphedema pumps, may be considered adjunctive to effectively manage lymphedema.