Lymphedema and Wound Care Flashcards

Lymphedema, Wound Pathophysiology, and Skin Screening.

Lymphedema

Fluid stagnation and edema due to dynamic or mechanical insufficiency.

Superficial Lymphatics Target

MLD (Manual Lymphatic Drainage)

Lymph Organs Example: biggest lymph node

Cisterna Chyli

Lymphatic Capillaries Function

Connect to vessels to form drainage system, large and highly permeable

Lymph Fluid Composition

Clear and contains lymphatic load, part of immune system.

Lymph Flow Sequence

Lymph capillaries → precollectors → lymph collectors → lymph nodes → thoracic duct or right lymphatic duct → venous system.

Lymph Angions

Valves in lymph collectors with autonomic contraction.

Lymph Node Functions

Protection (filter), immune, thickening of lymph.

Anastomoses

Allow drainage from one lymphatic territory to another.

Etiology of Lymphedema

Fluid stagnation and edema.

Mechanical Insufficiency

Transport capacity decreases, often due to lymph node removal.

Dynamic Insufficiency

Lymphatic load exceeds transport capacity.

Primary Lymphedema

10% of cases, result of congenital malformation or impaired lymphatics.

Secondary Lymphedema

Most common caused by filiariasis (worldwide) or cancer-related (US).

Phlebolymphedema

Chronic venous insufficiency with lymphedema.

Lipedema

Disorder of adipose tissue.

Symptoms of Lymphedema

Heaviness, delayed wound healing, lymphorrhea, increased risk of infection, negatively impacts functional mobility.

Fibrosis

Buildup of collagen formation in later stages of lymphedema.

Lymphorrhea

Clear fluid that weeps from skin.

Risk Factors for Lymphedema

Surgical lymph node removal, radiation therapy, surgical complications, time since surgery, increased BMI, air travel, inflammation, decreased lymphatic return, scar tissue formation.

ISL Lymphedema Stage 0

Subclinical, no edema present, but impaired lymph transport.

ISL Lymphedema Stage 1

Early onset, fluid buildup may subside with elevation; pitting edema present.

ISL Lymphedema Stage 2

Elevation no longer helps, fibrosis present, frequent skin infections (cellulitis).

ISL Lymphedema Stage 3

Skin thickening, hyperpigmentation, papillomas.

PT Tests and Measures for Lymphedema

DASH, Lymphedema Life Impact Scale, LEFS, circumferential measures, ROM, strength, functional assessment.

Unilateral Edema Severity: Mild

<3 cm difference in circumferential measures

Unilateral Edema Severity: Moderate

3-5 cm difference in circumferential measures

Unilateral Edema Severity: Severe

5 cm difference in circumferential measures

Lymphedema PT Interventions

Patient education, therapeutic exercise, manual lymphatic drainage, compression garments/short stretch bandages, vasopneumatic compression pump.

Manual Lymphatic Drainage (MLD)

Should be performed by trained/certified individual.

MLD Main Points

Diaphragmatic breathing, proximal lymph node stimulation and clearing, proximal to distal clear and flow.

Importance of Self-MLD

Patient should be taught self-MLD and be an active participant in their treatment plan.

Compression Bandages

Multilayer short stretch compression bandages used during the reduction phase

Wound Etiologies

Abrasions, skin tears, de-gloving.

Abrasions

Caused by friction to the skin’s surface. Superficial or partial thickness

Skin Tears

Traumatic wounds resulting from shear or friction forces that separate the epidermis from dermis. Partial thickness wound. Example: Elderly at risk.

De-Gloving

When the skin is avulsed from underlying tissue.

Surgical Wound

Closed with stables, sutures, or tissue adhesives

Radiation-Induced Skin Damage

Directly/indirectly destroys tissue, inhibits inflammatory response & proliferative phase of healing.

Vasculitis

General term in reference to inflammation of blood vessels.

Pyoderma Granulosum

Non-infectious progressive necrotizing skin condition.

Cancer Causing Wounds

Skin cancers (squamous cell, basal cell, melanoma) as well as other cancers can cause wounds (colorectal, sarcomas, ovarian, lung, etc.)

Arterial Disease Process

Narrowing, distal extremities (think of frost bite=black gangrene)

Venous Disease Process

Leaky veins with hemosiderin staining.

Pressure Injury Process

Caused by tissue ischemia from pressure. DTI - don’t know depth of injury, just like pressure injury covered in black eschar.

Neuropathic Wound Process

Typically dying back neuropathy (stocking/glove); arteries hardened and potentially narrow.

Burns Pathophysiology

Thermal, Electrical, Chemical size: % TBSA or Lund and Browder Chart (more for pediatrics)

Skin Screening

Moles during exam, hemosiderin staining, lack of hair on legs, cold distal extremities

What to Consider with Lacking Blood Flow

Cuts off nutrients, oxygen to distal extremities then to necrosis

A1c Value Relation to Wounds

Need to understand; Hyperglycemia changes RBCs, platelets, and capillaries which alters blood flow and increases microvascular pressure

Immobilization Risk

At risk for developing wounds

Lack of Sensation

Unaware of injuries

Corticosteroids Risks

Weakened immune system, thinning skin

Sun Exposure Risk

At higher risk for skin cancers

Normal mole

A small brown spot or growth that appears in the first few decades of life. It can be flat or raised and generally is round.

Actinic Keratosis

The most common precancer, it's a small, crusty, bump. Colors vary. It can itch and bleed and can turn into squamous.

Dysplastic Nevi

These noncancerous moles resemble melanoma in color variation within the blemish and sometimes in their unusual shapes and border irregularities.

Basal Cell

This is the most common skin cancer. This nonlethal blemish can be a shiny bump, a pink growth, a scar-like area or an open sore that doesn't heal easily.

Squamous Cell

Persistent bleeding is common with this rarely deadly cancer. Warts, scaly patches, open sores and rapidly growing bumps are telltale signs.

Melanoma

This deadly cancer is usually larger than a pencil's eraser, multicolored and changes size and shape. Also look for asymmetry and uneven borders.

Lymphedema Definition

Swelling due to lymphatic system blockage

Manual Lymphatic Drainage Targets

Superficial lymphatic vessels

Cisterna Chyli Location

Abdomen

Lymph Capillaries Permeability

Highly Permeable

Lymph

Fluid in the Lymphatic System

Lymph Node

Filters Lymph

MLD Sequence Flow

Proximal To Distal

Filiariasis

Mosquito-born secondary cause of Lympedema

Lymphedema Stage 0 Symptoms

No edema, impaired lymph transport

Radiation Risk Factor

Decreased Immune Response

DASH and LEFS

Lymphedema PT test and measure

Circumferential Measurement Difference (Mild)

<3cm

Manual Lymphatic Drainage Therapist Qualification

Trained and Certified

Stockinette Use

During Lymphedema Reduction

ABI Test

Arterial Blood Flow

Venous Leg Ulcer Bandaging

Multilayer Compression

Superficial Wound Type

Abrasion

Skin Tear Cause

Shear and Friction Forces

Radiation skin damage

Inhibits inflammatory response and proliferative phase of healing

Vasculitis Symptoms

Purple or red spots or bumps, clusters of small dots or splotches, bruises, hives

Pyoderma gangrenosum characteristics

Progressive necrotizing skin condition; painful papule, vesicle, or pustule and progresses to full thickness ulceration; irregular boarders and undermining common.

Cancer atypical wound referral

Unusual location, Unusual wound bed texture, Atypical age group, Abnormal appearance of periwound tissue/skin

Gangrene caused by:

Arterial Disease

Hemosiderin Staining

Venous Leaks

Pressure Injuries

tissue ischemia from pressure

Neuropathic Foot Ulcers

Often on the sole of foot

Burns: Medical Management

Pain control, infection management, fluids, nutrition, covering the area (surgery), psychological health

Skin Screening

Moles during exam, hemosiderin staining, lack of hair on legs, cold distal extremities, Post-surgical patients

Extended Periods Immobility

Developing Wounds

Long-time Steroid Use:

Weakened immune system, thinning skin

Normal mole

Small brown spot or growth that appears in the first few decades of life. It can be flat or raised and generally is round.

Dysplastic Nevi

Noncancerous moles resemble melanoma in color variation within the blemish and sometimes in their unusual shapes and border irregularities.

Basal Cell

Most common skin cancer. Nonlethal blemish can be a shiny bump, a pink growth, a scar-like area or an open sore that doesn't heal easily.

Claudication

Symptoms of Arterial Disease Process

Volumetric Measurements

Measurements of Edema

Total Contact Casts

For Neuropathic Ulcers

Lund-Browder chart

Used to measure burns.

DTI

Don't know depth of injury of a pressure injury.

What to do before compression?

Rule out underlying arterial disease

Autonomic Contraction

Lymph Angions