Wound care management of a patient with stage III lymphedema.

July Aug 2012

Sheehan DD.

Source

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. dsheehan@luriechildren's.org

Abstract

PURPOSE:

The sequelae for patients living with stage III lymphedema, including immobility, functional impairment, isolation and emotional burden, that affect quality of life are highlighted.

METHOD:

The case patient's medical history upon initial evaluation, descriptive wound characteristics and treatment plan are described in detail.

RESULTS:

A comprehensive treatment regimen resolved the patient's wound.

DISCUSSION:

The definition, staging and prevalence of lymphedema are reviewed.

CONCLUSION:

Successful lymphedema wound treatment includes working with experienced healthcare providers, management of wound drainage and odor, the use of higher pressure compression, and complying with lifestyle changes.

Wiley Online Library

The Role of Skin Care in Lymphedema Managementt

The Role of Skin Care in Lymphedema Management

Skin care plays an essential role in both prevention of lymphedema in those patients at risk of developing this condition, and in the management of existing lymphedema. Current methods of cancer treatment lower the risk of developing lymphedema. However, if a patient had surgery involving the lymphatic system – a radical mastectomy for example – even many years ago, the risk for developing lymphedema will always be present, even if this patient never had any arm swelling. 

Prevention is in the patients’ best interest and a great tool to avoid the onset of lymphedema. The skin is the first line of defense against foreign invaders and is usually impermeable to bacteria and other pathogens. However, any defect in the skin such as burns, chafing, dryness, cuticle injury, cracks, cuts, splinters, and insect bites can present an entry site for pathogens or infectious agents and cause infection.

Patients who already have, or had lymphedema are susceptible to infections of the skin and nails. Lymphedematous tissues are saturated with protein-rich fluid, which serves as an ideal nutrient source for bacteria and other pathogens. Lymphedematous skin also tends to be dry and may become thickened and scaly, which increases the risk of skin cracks and fissures.  

Editor's note: See the full text of this article in

Lymphedema Today

This is an excellent website and you may want to take time to wander through it

How to Choose Skin Care Products

How to Choose Skin Care Products

Mon, 17 Dec 2007 16:01:29

The high absorption ability of the skin makes it necessary for individuals to choose personal skin care products with outmost care.

As a result, using personal care products containing one or probably more of the following ingredients is dangerous.

· Mineral Oil, Paraffin, and Petrolatum - Petroleum products coat the skin like plastic, clog the pores and create toxins, which can slow down cellular development and result in early aging.

· Parabens - It is widely used as a preservative in the cosmetic industry (including moisturizers) and is a carcinogen. It also has hormone-disrupting qualities and interferes with the body's endocrine system.

· Phenol carbolic acid - Found in many lotions and skin creams. It can cause circulatory collapse, paralysis, convulsion, coma and even death caused by respiratory failure.

· Propylene glycol - it is used as a moisturizer in cosmetics and as a carrier in fragrance oils. It can cause dermatitis, kidney or liver abnormalities, and may inhibit skin cell growth or cause skin irritation.

· Acrylamide - Which is found in many hand and face creams, is linked to different tumors.

· Sodium laurel or lauryl sulfate (SLS) - also known as sodium laureth sulfate (SLES) - Found in car washes, engine degreasers, garage floor cleaners and in over 90% of personal care products.

It breaks down the skin's moisture barrier, easily penetrates the skin, and allows other chemicals to easily penetrate as well.

Combined with other chemicals, SLS becomes a 'nitrosamine', a potent class of carcinogen. It can also cause hair loss. SLES is sometimes disguised with the labeling 'comes from coconut' or 'coconut-derived'.

· Toluene - Poison! Danger! Harmful or fatal if swallowed! Harmful if inhaled or absorbed through the skin. Made from petroleum or coal tar, and found in most synthetic fragrances.

Chronic exposure is linked to anemia, lowered blood cell count, liver or kidney damage, and may affect the developing fetus.

· Dioxane - Found in compounds known as PEG, Polysorbates, Laureth, ethoxylated alcohols. It is common in a wide range of personal care products and is considered a carcinogen.

*Contributed by Anne, RN and member. Moderator of Advocates for Lymphedema

Antioxidant nutrients and skin protection

Antioxidant nutrients and skin protection

Free radical damage is one of the principal mechanisms of aging. Free radicals are highly and indiscriminately reactive chemicals that can damage any structure in living cells. The most common source of free radicals is normal burning of fuel that occurs in every cell every minute of every day. (Generally, the more free radicals a species produces, the shorter its life span.) Skin suffers additional free radical damage from sunlight and pollutants. Topical antioxidants provide some protection against environmental damage to the skin and may be somewhat effective in slowing down the skin aging. However, topical antioxidants are relatively unreliable. Their effect depends on skin permeability, other ingredients in the cream and many other factors. It appears that increasing oral intake of some antioxidants may additionally protect skin from free radicals. Keep in mind, however, that relatively little solid research has been done specifically on skin benefits of oral or topical antioxidants and much of the supporting evidence is indirect.

A very important chemical property for an oxidant is its solubility in water and fat (or oil). Basically, living organisms have two types of internal media, watery extra- and intracellular space and oily membranes that serve as partitions enclosing individual cells and various intracellular compartments. Water-soluble antioxidants are effective mainly in extra- and intracellular fluid, whereas fat-soluble antioxidants protect biological membranes. Both types of antioxidants are needed to create an effective shield against free radicals for the entire body, and skin in particular.

VITAMIN E

Vitamin E is a principal fat soluble antioxidant vitamin in the body. It protects cellular membranes, lipoproteins and other “oily” structures. Skin is high in unsaturated fatty acids (“oily” molecules especially susceptible to free radical damage), and can benefit from vitamin E protection (both oral and topical).

FLAVONOIDS

Flavonoids are a diverse group of plant pigments with antioxidant properties. These substances are responsible for color in many fruits, vegetables and flowers. In addition to providing color that attracts insects or animals, these pigments protect plants from environmental stress. In addition to being potent antioxidants, some flavonoids have antiallergic, anti-carcinogenic, anti-viral and anti-inflammatory activity. Over 4,000 flavonoids have been characterized and classified, but only a few have been researched. As far as skin benefits are concerned, two classes of flavonoids appear to be especially beneficial: proanthocyanins (found in grapes and pine bark) and polyphenols (found in green tea).

Coenzyme Q10, Lipoc acid, Cysteine, Methlonine

Coenzyme Q10, lipoic acid, cysteine and methionine are potent antioxidants. But they also play other roles that are at least as important as their antioxidant activity. See also the article about conditionally essential nutrients in this section.

Smart Skin Care

The Puzzle - An Inside Glimpse of Lymphedema - New Book

The Puzzle - An Inside Glimpse of Lymphedema - New Book

by The Lighthouse Lymphedema Network

The book is compiled so that people who have been touched by lymphedema can share their stories; their trials and tribulations, their sadness and disappointments, their strength and hopes. It is intended to encourage, educate and inspire patients and loved ones, who can often feel isolated and uninformed. We hope to increase awareness and general knowledge of a condition that is often overlooked and misdiagnosed, yet which can have monumental physical and emotional impact on the lives that it affects.

Not every story has a happy ending, yet there is hope. By sharing these stories with one another, we can learn from the struggles and successes that others have experienced, and can help each other to live well with lymphedema.

How do I get this book ???

The book is available:

Lighthouse Lymphedema Network Book

10240 Crescent Ridge Drive

Roswell, GA 30076

on the new Lighthouse Lymphedema Network Store page

http://lighthouselymphedema.org/LLNStore/Storewelcome.htm

Remember: All profits are going straight into our "Bag Fund" that assists needy lymphedema patients in securing desperately needed compression garments.

Included in the book are four articles by Pat O'Connor

Major Functions of the Skin

Major functions of the skin

Protection
Sensation Insulation Temperature regulation

We will discuss each of these in turn. Please note, however, that sensation was already covered in enough detail in the Unit 4 main page.

Protection:

Skin protects everything that lies beneath it. It acts as a cushion against insult to the body. It alerts the body of danger (through sensation). Its continuous, tightly connected surface, lightly coated with oily sebum maintains a distinct fluid environment within our bodies from that environment encountered outside of our bodies. Also, the skin, by being such an effective barrier, is our bodies' first line of defense against invading parasites/diseases.

Insulation:

Our bodies are supposed to maintain a specific temperature, 37 ºC (or 98.6 ºF) at all times. We need to maintain that temperature in order for our cells to perform properly. So, our bodies use energy to produce heat just to keep our temperature up.

Meanwhile, heat continually escapes from our bodies. It escapes in four ways: 1) radiation; 2) conduction; 3) convection; and 4) evaporation. These four ways require some further explanation. After the following explanation, we will return to the notion of insulation and how that helps to prevent heat loss.

• Radiation: This is the main way we lose heat!

You know how if you light a match, the heat spreads out in all directions from the flame? We talk about the heat as radiating out from the heat source, the flame. Well, our bodies radiate heat, too. They contain heat, much like a flame contains heat (but just less of it). Heat radiates out from our bodies in all directions. Heat can be described as traveling in rays that are called infrared heat rays.

Some organisms can actually see infrared rays. For example, killer snakes have organs that detect these rays and use them to find warm-blooded animals--even in the dark. For these snakes, it is as if they see the heat rays radiating out of the warm-blooded animal. Humans do not have any ability to see infrared heat rays, that's why the notion of their existence seems weird to us. But humans have manufactured machines that can sense these infrared heat rays-- so that through this machine people seem colored from red (very hot) to blue (very cold).

• Conduction:

All that this means is that if your body is up against something that is colder than it, heat gets transferred from your body to the colder item. For example, after you have been sitting in a chair for a while, you may notice that you have warmed it up. Another more important example is that the air that is around your body, assuming it is cooler than 37 ºC also warms up just by being next to your body.

• Convection:

You know that heat rises and cold air falls. We all know that. Well, the warmer air that is next to your body, as mentioned above in the "conduction" section, also rises. When it does so, cooler air that has fallen replaces it. This means that we continually lose the insulating, warmer air layer from our bodies, and so we end up losing more heat.

• Evaporation:

In order for water to evaporate, it needs more kinetic energy (energy of molecular motion)... this is proportional to temperature. So, another way to say it is that water needs higher temperatures or more heat to evaporate. Where does it get this heat from? The water comes from within our bodies and is released to the surface of our bodies by the sweat glands. If it is going to evaporate, it needs more heat-- so it gets this heat from our bodies and takes it with it when it evaporates. That leaves less heat behind, and we feel cooler.

Back to insulation...

The underlying layer of hypodermis with its adipose tissue (as well as the dense nature of the dermis) creates an insulating layer against heat loss. For example, infrared rays may not make it through the adipose, but instead may be absorbed by the adipose tissue.

Also, when we begin to get cold, we excite our arrector pili muscles and then our skin hairs stand up on end. This increases the thickness of the insulating layer of air around the outside of our bodies, and helps to slow down conduction and convection heat loss.

Finally, we can slow down sweat gland secretion, to decrease the loss of heat through evaporation. But since we can also speed it up, this fits even better in the "temperature regulation" section.

Temperature Regulation:

This is a bit different from mere insulation. In order to regulate temperature you have to be able to both increase it and decrease it. Imagine walking outside on a hot summer's day... it is hotter outside than your body temperature. How come you don't overheat right away? How come you can stay outside for hours (if it is not really, really hot) without passing out? Then you go inside. You enter an air conditioned building, which is set really low. It seems cold at first, but you "get used to it." How come? What did your body do?

Your body handles these situations by having your skin respond to them. Your skin can help you to lose or retain heat, depending on the situation. Kind of like having a thermostat in your home that always keeps it at 72 ºF, whether it has to run the heat or the air-conditioning to do it. Such a fancy thermostat in our homes would be rather expensive. Our skin does it automatically, using only cellular energy.

The main way that our body handles temperature changes is by altering blood vessel diameter in your skin. If you are too hot, then your blood is also too hot. You cancool down the entire body by cooling down your blood. How? Dilate your dermal blood vessels. Dilation increases their diameter, and, since we have a constant volume of blood that is running through our blood vessels under pressure, if this blood has a lower pressure way to go, like through large vessels, it will (*click here for another explanation of this pressure notion). So blood will flow into your dermal blood vessels. This causes it to run very near the surface of your body, and allows for heat to escape from your blood quite easily into the air.

Note that in the above situation, more blood enters the skin-- this causes your skin to look flushed. That is a common symptom of being hot.

If you are too cold, you can warm up your body by constricting your dermal blood vessels. This prevents too much blood from entering your skin, keeping it well inside your body and away from any possible heat loss to the environment. Your book describes this mechanism in Figure 6.12.

The other means by which we can regulate our temperature are: regulating sweat gland secretion, contracting our arrector pili muscles, and shivering. Shivering, however, occurs in muscles deeper than the skin... it's just that the heat that makes is trapped inside our bodies by our insulation. Shivering works because active muscles release heat, so it forces muscles to become active.

Keep in mind that this type of temperature regulation shows very fine tuning characteristic of all homeostatic mechanisms.

*note: Think about it this way, if you want to water your huge garden with a hose, and you have two different hoses available (one with a wide diameter and one with a small diameter), which hose would you use? You would probably use the wide diameter hose, because with the same amount of water pressure from your faucet, you could water your garden much faster. Water runs through a wider hose faster than it does through a narrow hose. Same with blood. Blood will go faster and more easily into larger diameter blood vessels. Since blood is constantly moving through our bodies' blood vessels, more will go through the dilated vessels over the course of minutes or hours than will go through constricted vessels

The Role of Skin Care in Lymphedema Management

Skin care plays an essential role in both prevention of lymphedema in those patients at risk of developing this condition, and in the management of existing lymphedema. Current methods of cancer treatment lower the risk of developing lymphedema. However, if a patient had surgery involving the lymphatic system – a radical mastectomy for example – even many years ago, the risk for developing lymphedema will always be present, even if this patient never had any arm swelling.

Prevention is in the patients’ best interest and a great tool to avoid the onset of lymphedema. The skin is the first line of defense against foreign invaders and is usually impermeable to bacteria and other pathogens. However, any defect in the skin such as burns, chafing, dryness, cuticle injury, cracks, cuts, splinters, and insect bites can present an entry site for pathogens or infectious agents and cause infection.

Patients who already have, or had lymphedema are susceptible to infections of the skin and nails. Lymphedematous tissues are saturated with protein-rich fluid, which serves as an ideal nutrient source for bacteria and other pathogens. Lymphedematous skin also tends to be dry and may become thickened and scaly, which increases the risk of skin cracks and fissures.

The process of inflammation may not only make lymphedema much worse by increasing the swelling, but can also develop into a serious medical crisis. The basic consideration in skin and nail care is therefore the prevention and control of infections, which includes proper cleansing and moisturizing techniques with the goal of maintaining the health and integrity of the skin.

Suitable ointments or lotions formulated for sensitive skin, radiation dermatitis and lymphedema should be applied before the application of lymphedema bandages while the patient is in the decongestive phase of the treatment. Once the limb is decongested and the patient wears compression garments, moisturizing ointments should be applied twice daily.

Ointments, as well as soaps or other skin cleansers used in lymphedema management, should have good moisturizing qualities, contain no fragrances, be hypo-allergenic and should be in either the neutral or acidic range of the pH scale (around pH 5). To identify possible allergic reactions to skin care products, they should be first tested on healthy skin before the initial application to areas affected by lymphedema.

Tight fitting compression sleeves or stockings, as well as materials used in compression bandaging may also cause skin irritation. Some patients may be allergic to a certain material used for compression therapy. This situation can be remedied by switching to other materials.

In mosquito infected areas it is necessary to apply insect repellents to the affected extremity (some moisturizers contain natural repellents) to avoid bites, which are a common cause for infections.

For an excellent resource regarding all aspects of skin care, I would like to refer you to this link: http://www.lymphedemapeople.com/wiki/doku.php?id=skin_care

For a more in-depth look at other measures to avoid the onset of lymphedema, stay tuned for future blogs on this site.

**Editor's note: This is a great site for dependable, trustworthy information on lymphedema. The author/creator is Joachim Zuther, founder of the Academy of Lymphatic Studies (ACOL)

Lymphedema Today