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Hope for first drug against lymphedema

lymphedema drug against breast cancer medicine wca

Many cancer patients, especially those who’ve undergone breast cancer treatment, experience painful, swollen limbs, a condition called lymphedema.

Now researchers say they’ve found an underlying mechanism that could eventually lead to the first drug therapy for the debilitating condition. (more…)

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Lymphedema

Lymphedema

Lymphedema is a collection of fluid that causes swelling (edema) in the arms and legs.

  1. Unna Boot

    An Unna boot is a special dressing of inelastic gauze impregnated with zinc, glycerin, or calamine that becomes rigid when it dries. It is used for managing venous leg ulcers and lymphedema in patients who are ambulatory. When the patient… Read more…

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  2. Positive Stemmer’s sign yields a definitive lymphedema diagnosis in 10 seconds or less

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA In a busy wound clinic, quick and accurate differential diagnosis of edema is essential to appropriate treatment or referral for comprehensive care. According to a 2010 article in American Family Physician, 80% of… Read more…

    Comments: 4 Comments

  3. Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema

    By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA An estimated 7 million people in the United States have venous disease, which can cause leg edema and ulcers. Approximately 2 to 3 million Americans… Read more…

    Comments: 3 Comments

  4. Clinical Notes

    2012 guideline for diabetic foot infections released Foot infections in patients with diabetes usually start in a wound, most often a neuropathic ulceration. So clinicians can better manage diabetic foot infections, the Infectious Diseases Society of America (IDSA) published “2012… Read more…

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  5. Chronic venous insufficiency with lower extremity disease: Part 2

    By Donald A. Wollheim, MD, WCC, DWC, FAPWCA To begin appropriate treatment for chronic venous insufficiency (CVI), clinicians must be able to make the correct diagnosis. Part 1 (published in the March-April edition) described CVI and its presentation. This article… Read more…

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  6. Lymphedema 101 – Part 2: Treatment

    By Steve Norton, CDT, CLT-LANA Editor’s note: Part 1 of this series, published in the September-October issue, discussed lymphedema pathology and diagnosis. This article, Part 2, covers treatment. Traditional treatment approaches Traditionally, lymphedema treatment has been approached without a clear… Read more…

    Comments: 1 Comment

  7. Skin problems with chronic venous insufficiency and phlebolymphedema

    Dermatologic difficulties: Skin problems in patients with chronic venous insufficiency and phlebolymphedema By Nancy Chatham, RN, MSN, ANP-BC, CWOCN, CWS; Lori Thomas, MS, OTR/L, CLT-LANA; and Michael Molyneaux, MD Skin problems associated with chronic venous insufficiency (CVI) and phlebolymphedema are… Read more…

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  8. Chronic venous insufficiency with lower extremity disease: Part 1

    By Donald A. Wollheim, MD, WCC, DWC, FAPWCA Chronic venous insufficiency (CVI) is the most common cause of lower extremity wounds. The venous tree is defective, incapable of moving all the blood from the lower extremity back to the heart.… Read more…

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  9. Lymphedema 101 – Part 1: Understanding the pathology and diagnosis

    By Steve Norton, CDT, CLT-LANA Lymphedema is characterized by regional immune dysfunction, distorted limb contours, and such skin changes as papillomas, hyperkeratosis, and increased girth. The condition may involve the limbs, face, neck, trunk, and external genitals; its effects may… Read more…

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  10. Clinical Notes: Radiation & Lymphedema, Decline in Diabetic Foot Ulcers

    Radiation and lymphedema Radiation therapy doesn’t increase the incidence of lymphedema in patients with node-negative breast cancer, according to research presented at the American Society for Radiation Oncology’s 56th Annual Meeting held this fall. The study consisted of a secondary… Read more…

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  11. Bedside ankle-brachial index testing: Time-saving tips

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA A hot flush of embarrassment creates a bead of sweat on my forehead. “I’ve got to get this measurement,” I plead to myself. One glance at the clock tells me this bedside ankle-brachial… Read more…

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  12. Clinical Notes : Diabetes, medical honey, silver dressings, clostridium

    Guidelines for optimal off-loading to prevent diabetic foot ulcers  “The management of diabetic foot ulcers through optimal off-loading,” published in the Journal of the American Podiatric Medical Association, presents consensus guidelines and states the “evidence is clear” that off-loading increases healing of… Read more…

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  13. Clinical Notes

    Diabetes carries high economic burden According to a study published in Diabetes Care, the economic burden associated with diagnosed diabetes (all ages) and undiagnosed diabetes, gestational diabetes, and prediabetes (adults) exceeded $322 billion in 2012, amounting to an economic burden… Read more…

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  14. Clinical Notes: Moldable Skin Barrier, hypoglycemia, diabetic food ulcers

    Moldable skin barrier effective for elderly patients with ostomy A study in Gastroenterology Nursing reports that compared to a conventional skin barrier, a moldable skin barrier significantly improves self-care satisfaction scores in elderly patients who have a stoma. The moldable skin barrier also caused less irritant dermatitis… Read more…

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  15. Clinical Notes: Aspirin, Skin Infections, NPWT surgical incisions

    Aspirin inhibits wound healing A study in the Journal of Experimental Medicine describes how aspirin inhibits wound healing and paves the way for the development of new drugs to promote healing. The authors of “12-hydroxyheptadecatrienoic (12-HHT) acid promotes epidermal wound… Read more…

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  16. Clinical Notes: Pressure Injury Prevention, Diabetes, LIV

    Incidence density best measure of pressure-ulcer prevention program According to the National Pressure Ulcer Advisory Panel (NPUAP), incidence density is the best quality measure of pressure-ulcer prevention programs. Pressure-ulcer incidence density is calculated by dividing the number of inpatients who develop… Read more…

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  17. Clinical Notes: Pressure-Ulcer Data, Diabetic Foot Ulcers, IFG & HbA1c

    Hospital pressure-ulcer comparison data not accurate Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine. “Hospital report cards for hospital-acquired pressure ulcers: How good… Read more…

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  18. Clinical Notes: Modified Braden Risk Score, dialysis patients, plantar

    Modified Braden risk score proposed A study in Ostomy Wound Management states the risk classification of patients using Braden Scale scores should comprise three (rather than five) levels: high risk, with a total score ≤11; moderate risk, with a total… Read more…

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  19. Clinical Notes

    Diabetes ‘ABC’ goals improve, but work remains The number of people with diabetes who are meeting the ABC goals—hemoglobin A1C, blood pressure, and LDL cholesterol—has risen significantly in recent years, according to a study published by Diabetes Care. Patients meeting… Read more…

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  20. Clinician Resources

      Here are resources that can help you in your busy clinical practice by giving you information quickly. Pressure ulcer resources Instead of searching through Google or another search engine for pressure ulcer resources, start with this comprehensive list on… Read more…

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  21. Clinical Notes: Low BMD, CKD, hypoglycemia, HBOT

    Low BMD common after ostomy Low bone mineral density (BMD) is common in patients with inflammatory bowel disease who have a stoma placed, according to “Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory… Read more…

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  22. Clinical Notes

    New wound-swabbing technique detects more bacteria The new Essen Rotary swabbing technique takes a few seconds longer to perform than traditional techniques, but improves bacterial count accuracy in patients with chronic leg ulcers, according to a study published by Wounds… Read more…

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  23. Clinician Resources: Intl Ostomy Assoc., Substance Use Disorder

    Take a few minutes to check out this potpourri of resources. International Ostomy Association The International Ostomy Association is an association of regional ostomy associations that is committed to improving the lives of ostomates. Resources on the association’s website include:… Read more…

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  24. Clinical Notes: biofilm, bariatric surgery, statins and more

    Management of biofilm recommendations The Journal of Wound Care has published “Recommendations for the management of biofilm: a consensus document,” developed through the Italian Nursing Wound Healing Society. The panel that created the document identified 10 interventions strongly recommended for clinical practice; however, panel members noted that, “there… Read more…

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  25. Providing evidence-based care for patients with lower-extremity cellulitis

    By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD Cellulitis is an acute, painful, and potentially serious spreading bacterial skin infection that affects mainly the subcutaneous and… Read more…

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  26. Clinical Notes: Debridement, Optimal Wound Healing, Diabetes, Sacral Wounds

    Frequent debridement improves wound healing A study in JAMA Dermatology reports that fre­quent debridements speed wound healing. “The more frequent the debridement, the better the healing outcome,” concludes “Frequency of debridements and time to heal: A retrospective cohort study of… Read more…

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  27. Clinical Notes: diabetes, LMW heparin, dressings, lymphedema

    Factors affecting medication adherence in patients with diabetes identified Factors associated with better adherence to antidiabetic medications taken by patients with diabetes include older age, male sex, higher education, higher income, use of mail-order vs. retail pharmacies, primary care vs.… Read more…

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  28. Clinical Notes: Ischemia, Breast Cancer, ICU Patients

    Critical limb ischemia may not increase mortality risk in patients with diabetes Diabetic patients with critical limb ischemia (CLI) who are assessed quickly and treated aggressively do not have an increased risk of long-term cardiac mortality, according to a study… Read more…

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  29. A collaborative approach to wound care and lymphedema therapy: Part 1

    By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema… Read more…

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  30. Lymphedema and lipedema: What every wound care clinician should know

    Imagine you have a health condition that affects your life every day. Then imagine being told nothing can be done about it; you’ll just have to live with it. Or worse yet, your physician tells you the problem is “you’re just fat.” Many people with… Read more…

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  31. Clincal Notes: Analysis, Osteomyelitis, sickle cell, maggot

    Value of systematic reviews and meta-analyses in wound care “Systematic reviews and meta-analyses—literature-based recommendations for evaluating strengths, weaknesses, and clinical value,” in Ostomy Wound Management, discusses evidence-based practice and how systematic reviews (SRs) and meta-analyses (MAs) can help improve management… Read more…

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  32. Clinical Notes: Wound Photography, Lymphedema, GI Complaints

    Wound photography may motivate patients Having patients view photographs of their wounds can motivate them to become more involved in managing those wounds, according to a study in International Wound Journal, particularly when wounds are in difficult-to-see locations. In the… Read more…

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  33. Learning to love your job

    By Joan C. Borgatti, MEd, RN The alarm clock goes off too early, and you jump-start the day with a cup of coffee and a short stack of reasons why you hate your job. Sound familiar? Although you can’t expect… Read more…

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  34. Clinical Notes

    Mild compression diabetic socks safe and effective for lower extremity edema Diabetic socks with mild compression can reduce lower extremity edema in patients with diabetes without adversely affecting arterial circulation, according to a randomized control trial presented at the American… Read more…

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  35. Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

    Electrical stimulationElectrical stimulation and pressure ulcer healing in SCI patients A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound… Read more…

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  36. Clinical Notes: diabetic foot osteomyelitis, BIA, footwear

    Antibiotics and conservative surgery yield similar outcomes in patients with diabetic foot osteomyelitis A study in Diabetes Care finds that anti­biotics and surgery have similar outcomes related to rate of healing, time of healing, and short-term complications in patients who… Read more…

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  37. Clinician Resources: Pressure-Injuries, Ostomy, Lymphedema, Delirium

    Here is a round-up of resources that you may find helpful in your practice. New illustrations for pressure-injury staging The National Pressure Ulcer Advisory Panel (NPUAP) has released new illustrations of pressure injury stages. You can download the illustrations, which include normal Caucasian and non-Caucasian skin… Read more…

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  38. NYU docs use machine learning

    Lymphedema causes unsightly swelling in the arms and legs. But researchers Mei Fu and Yao Wang have an idea for catching early symptoms sooner. Researchers at NYU’s Tandon School of Engineering have teamed up with those from the university’s Rory Meyers College of… Read more…

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  39. Stand up to bullies

    By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS At some point, most of us have encountered a bully—most commonly when we were kids. You might think that as we get older, bullying wouldn’t be a problem we have to deal… Read more…

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  40. Clinical Notes

    Study finds less-invasive method for identifying osteomyelitis is effective Researchers have found that using hybrid 67Ga single-photon emission computed tomography and X-ray computed tomography (SPECT/CT) imaging combined with a bedside percutaneous bone puncture in patients with a positive scan is… Read more…

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  41. When you can’t rely on ABIs

    By Robyn Bjork, MPT, CWS, WCC, CLT-LANA One of the worst fears of a wound care clinician is inadvertently compressing a leg with critical limb ischemia—a condition marked by barely enough blood flow to sustain tissue life. Compression (as well… Read more…

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  42. A collaborative approach to wound care and lymphedema therapy: Part 2

    By Erin Fazzari, MPT, CLT, CWS, DWC Have you seen legs like these in your practice? These legs show lymphedema and chronic wounds before treatment (left image) and after treatment (right image) with complex decongestive therapy (CDT)—the gold standard of… Read more…

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  43. Role of rehab in wound care

     By Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DCCT How many times have you heard someone say, “I didn’t know PTs did wound care”? Statements like this aren’t uncommon. The role of physical therapists (PTs), occupational therapists,… Read more…

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Clinician Resources: Pressure-Injuries, Ostomy, Lymphedema, Delirium

Here is a round-up of resources that you may find helpful in your practice.

New illustrations for pressure-injury staging

The National Pressure Ulcer Advisory Panel (NPUAP) has released new illustrations of pressure injury stages. You can download the illustrations, which include normal Caucasian and non-Caucasian skin illustrations for reference.

There is no charge for the illustrations as long as they are being used for educational purposes, but donations to support the work of NPUAP are appreciated. (more…)

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Lymphedema and lipedema: What every wound care clinician should know

Imagine you have a health condition that affects your life every day. Then imagine being told nothing can be done about it; you’ll just have to live with it. Or worse yet, your physician tells you the problem is “you’re just fat.”

Many people with lymphedema or lipedema have no idea their condition has a name or that many other people suffer from the same thing. Although lymphedema and lipedema can’t be cured, proper management and resources can help patients cope. This article improves your grasp of these conditions, describes how to recognize and manage them, and explains how to support your patients.

To understand lymphedema and lipedema, first you need to understand how the lymphatic system functions. It makes lymph, then moves it from tissues to the bloodstream. It also plays a major role in the immune system, aiding immune defense. In addition, it helps maintain normal fluid balance by promoting fluid movement from the interstitial tissues back to the venous circulation. (See Lymphatic system: Four major functions.)

If the lymphatic system is impaired from a primary (hereditary or congenital) condition or a secondary problem, lymphedema can result. In this chronic, potentially progressive, and incurable condition, protein-rich fluid accumulates in the interstitial tissues.

Lymphedema basics

Lymphedema occurs in four stages.

Stage 0. During this stage (also called the subclinical or latency stage), transport capacity of the lymphatic system decreases but remains sufficient to manage normal lymphatic loads. Signs and symptomsaren’t evident and can be measured only by sensitive instruments, such as bioimpedance spectroscopy and optoelectronic volumetry. Without such instruments to quantify volume changes, diagnosis may rest on subjective complaints.

In this stage, limited functional reserve of the lymphatic system leads to a fragile balance between subnormal transport capacity and lymphatic loads. Added stress on the lymphatic system (as from extended heat or cold exposure, injury, or infection) may cause progression to stage 1.

Providing appropriate patient information and education, especially after surgery, can dramatically reduce the risk that lymphedema will progress to a more serious stage.

Stage 1. Considered the spontaneously reversible stage, stage 1 is marked by softtissue pliability without fibrotic changes. Pitting can be induced easily. In early stage 1, limb swelling may recede over – night. With proper management, the patient can expect the extremity to decrease to a normal size compared to that of the uninvolved limb. Otherwise, lymphedema is likely to progress to stage 2.

Stage 1 lymphedema may be hard to distinguish from edemas from other causes. Clinicians must rely on the patient history and monitor for swelling resolution with conventional management, such as compression and elevation, or note if swelling persists despite these standard interventions.

Stage 2. Sometimes called the spontaneously irreversible stage, stage 2 is identified mainly from tissue proliferation and subsequent fibrosis (called lymphostatic fibrosis). The fluid component can be removed spontaneously, but removal of the increased tissue proliferation (initially irreversible) takes more time. Tissue proliferation stems from long-standing accumulation of protein-rich fluid; over time, the tissue hardens and pitting is hard to induce. In many cases, swelling volume increases, exacerbating the already compromised local immune defense.

Consequently, infections (particularly cellulitis) are common; these, in turn, increase the volume of the affected area. Proper treatment can reduce volume.

With proper care (complete decongestive therapy [CDT]), lymphedema can stabilize during stage 2. But patients with chronic or recurrent infections are likely to progress to stage 3.

Stage 3. Also called lymphostatic elephantiasis, this stage is marked by further fluid volume increases and progression of tissue changes. Lymphostatic fibrosis becomes firmer and other skin alterations may occur, including papillomas, cysts, fistulas, hyperkeratosis, fungal infections, and ulcers. Pitting may be present. Natural skinfolds deepen (especially those of the dorsum of the wrist or ankle) and, in many cases, cellulitis recurs.

If lymphedema management starts during this stage, reduction can still occur. Even in extreme cases, with proper care and patient adherence to treatment, lymphostatic elephantiasis can be reduced so the leg is a normal or near-normal size.

Assessment and diagnosis

A thorough physical examination is the gold standard for diagnosing lymphedema. A complete patient history, body-systems review, inspection, and palpation can help determine if edema is lymphedema.

Clinically, the only test with proven reliability and validity in diagnosing lymphedema is the Stemmer sign. Fibrotic changes associated with lymphedema can lead to thickened skin over the proximal phalanges of the toes or fingers. If you can’t tent or pinch the skin on the involved extremity, lymphedema is present (a positive Stemmer sign). However, a negative finding (soft, pliable tissue) doesn’t rule out  lymphedema because the condition may be in an early stage, before tissue proliferation and fibrosis have set in.

Management

Although incurable, lymphedema can be managed successfully through CDT. This approach involves proper identification of lymphedema, manual lymph drainage, skin and nail care, patient education, compression, and exercise.

CDT has two phases:

Phase I, the intensive phase, continues until the extremity has decongested or reached a plateau. The clinician provides treatments and educates the patient about all aspects of CDT to prepare him or her for phase II. Phase I can last several weeks to several months depending on lymphedema severity.

Phase II, the maintenance phase, begins once the extremity has decongested or plateaued. This phase still focuses on CDT, but now the patient, not the clinician, is responsible for all care. The goal is to reduce limb size while enabling the patient to become self-sufficient in managing lymphedema. Although CDT can bring significant improvements in limb size, skin quality, and function, patients must remember that phase II continues lifelong. Be sure to provide education about ongoing self-management strategies.

Lipedema: The disease they call “fat”

Lipedema is a painful disorder of fat deposition. Pathologic deposition of fatty tissue (usually below the waist) leads to progressive leg enlargement. Like lymphedema, lipedema is incurable but manageable. Unless managed properly, lipedema can reduce mobility, interfere with activities of daily living, and lead to secondary lymphedema. (See Lipedema stages.)

Lipedema commonly is misdiagnosed as lymphedema. However, lymphedema involves protein-rich fluid, whereas lip edema is a genetically mediated fat disorder. Because lipedema resists diet and exercise, it can lead to psychosocial complications. Lipedema occurs almost exclusively in women; typically, onset occurs between puberty and age 30. One unpublished epidemiologic study puts lip edema incidence in females at 11%. Some patients have a combination of lipedema and lymphedema. (See Viewing lipolymphedema.)

Assessment and diagnosis

As with lymphedema, lipedema diagnosis rests on clinical presentation. Lipedema characteristics include bilateral and symmetrical involvement, absence of pitting (because lipedema isn’t a fluid disorder), soft and pliable skin, and filling of the retromalleolar sulcus (called the fat pad sign.)

Key signs and symptoms include:

• feeling of heaviness in the legs (aching dysesthesia)

• easy bruising

• sensitivity to touch (called “painful fat syndrome”)

• orthostatic edema

• oatmeal-like changes to skin texture.

Nearly half of lipedema patients are overweight or obese, but many appear of normal weight from the waist up. Essentially, the upper and lower extremities don’t match. The lower extremities typically show fatty deposits extending from the iliac crest to the ankles, sparing the feet. (See Lipedema patterns.)

Management

Lipedema is best  managed through weight control, as additional weight gain through adipose tissue tends to deposit in the legs. For patients with concomitant lymphedema (lipolymphedema), modified CDT helps reduce and manage lymphatic compromise. To address excess fat deposition, newer “wet” liposuction techniques have proven beneficial. These techniques gently detach adipose cells from the tissue, helping to preserve connective tissue and lymphatic vessels.

Know what to look for

In both lymphedema and lipedema, early identification and proper diagnosis are key. (See Differentiating lymphedema and lipedema.) A thorough history and physical exam will likely lead to an accurate diagnosis, if clinicians know what to look for. Proper diagnosis and treatment can prevent expensive and ineffective interventions, which can negatively affect both the patient’s condition and psychological well being.

Heather Hettrick is an associate professor at Nova Southeastern University, Department of Physical Therapy in Fort Lauderdale, Florida.

Selected references

Fat Disorders Research Society. Lipedema description.

Fife CE, Maus EA, Carter MJ. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care. 2010;23(2):81-92

Herbst KL. Rare adipose disorders (RADS) masquerading as obesity. Acta Pharmacol Sin. 2012;33(2):155-72.

Lipedema Project.

National Lymphedema Network. Position papers.

Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012;166(1):161-8.

Zuther J. A closer look at lipedema and the effects on the lymphatic system. December 13, 2012. lymphedemablog.com/2012/12/13/a-closer-look-at-lipedema-and-the-effects-on-the-lymphatic-system/

Zuther J. Stages of lymphedema. October 3, 2012.

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A collaborative approach to wound care and lymphedema therapy: Part 2

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By Erin Fazzari, MPT, CLT, CWS, DWC

Have you seen legs like these in your practice?

Before-After

These legs show lymphedema and chronic wounds before treatment (left image) and after treatment (right image) with complex decongestive therapy (CDT)—the gold standard of lymphedema care. The patient benefited from multidisciplinary collaboration between wound care and lymphedema therapists. (more…)

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Clinical Notes: diabetes, LMW heparin, dressings, lymphedema

Factors affecting medication adherence in patients with diabetes identified

Factors associated with better adherence to antidiabetic medications taken by patients with diabetes include older age, male sex, higher education, higher income, use of mail-order vs. retail pharmacies, primary care vs. nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. (more…)

Read More

A collaborative approach to wound care and lymphedema therapy: Part 1

By Erin Fazzari, MPT, CLT, CWS, DWC

Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema and wound care. (more…)

Read More

Skin problems with chronic venous insufficiency and phlebolymphedema

Dermatologic difficulties: Skin problems in patients with chronic venous insufficiency and phlebolymphedema By Nancy Chatham, RN, MSN, ANP-BC, CWOCN, CWS; Lori Thomas, MS, OTR/L, CLT-LANA; and Michael Molyneaux, MD

Skin problems associated with chronic venous insufficiency (CVI) and phlebolymphedema are common and often difficult to treat. The CVI cycle of skin and soft tissue injury from chronic disease processes can be unrelenting. If not properly identified and treated, these skin problems can impede the prompt treatment of lymphedema and reduce a patient’s quality of life.

This article reviews skin problems that occur in patients with CVI and phlebo­lymphedema and discusses the importance of using a multidisciplinary team approach to manage these patients. (more…)

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Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema

By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA

An estimated 7 million people in the United States have venous disease, which can cause leg edema and ulcers. Approximately 2 to 3 million Americans suffer from secondary lymphedema. Marked by abnormal accumulation of protein-rich fluid in the interstitium, secondary lymphedema eventually can cause fibrosis and other tissue and skin changes. (more…)

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Positive Stemmer’s sign yields a definitive lymphedema diagnosis in 10 seconds or less

By Robyn Bjork, MPT, CWS, WCC, CLT-LANA

In a busy wound clinic, quick and accurate differential diagnosis of edema is essential to appropriate treatment or referral for comprehensive care. According to a 2010 article in American Family Physician, 80% of lower extremity ulcers result from chronic venous insufficiency (CVI). In 2007, the German Bonn Vein Study found 100% of participants with active venous ulcers also had a positive Stemmer’s sign, indicating lymphedema. (more…)

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