You Can't Afford to Forget Lymphedema

Introduction: Chronic wounds are becoming an increasing economic and societal burden, growing with our aging population and the prevalence of diabetes mellitus, obesity, and peripheral vascular disease.  Several recent studies show that a multidisciplinary team in a wound center can better address the medical complexity of a patient with chronic wounds by streamlining the plan of care and continuity of treatment, resulting in improved outcomes. These team members may include plastic surgeons, vascular surgeons, podiatrists, nutritionists, and wound care specialists. However, a certified lymphedema therapist is rarely, if ever, included on this list.Methods:With over 250 million people worldwide and 10 million people in the United States with lymphedema, this is a condition that can not be ignored. Wound Care centers are seeing up to one third of their patients with wounds that concurrently present with lymphedema. One of the most common causes of lymphedema in the United States is chronic venous insufficiency. Venous leg ulcers represent 60-80% of all leg ulcerations and are due to chronic venous insufficiency or venous hypertension, with a recurrence rate of 80% within three months. The lymphatic system is negatively impacted by venous hypertension and promotes wound chronicity. Results:The lymphatic, venous and integumentary systems are interdependent, so treatment of these systems must be concurrent to be effective. The gold standard for treatment of venous insufficiency is compression therapy, of which lymphedema therapists have expert knowledge. Without addressing the edema or lymphedema, a wound cannot heal, nor remain closed if edema does not remain well managed.Discussion: Our outpatient clinic employs four physical therapists, all of whom are certified lymphedema therapists, and two of which are certified wound specialists. This allows us to not only treat the patient’s wound, but also their underlying lymphedema and venous insufficiency, as well as the functional impairments commonly seen in this population. All wound care clinics should include a certified lymphedema therapist in their staff to optimize wound healing more effectively and efficiently.References:Birkballe S, Karlsmark T, Noerregaard S, Gottrup F. A New Concept of a Multidisciplinary Lymphoedema Center: Established in Connection to a Department of Dermatology and the Copenhagen Wound Healing Center. British Association of Dermatologists. 2012;167:116-122. doi:10.1111/j.1365-2133.2012.10907.x. Ehmann S. Incorporating Specialized Lymphedema Therapy & the Wound Clinic. Today’s Wound Clinic. Published August 2015. Accessed February 2, 2024. https://www.hmpgloballearningnetwork.com/site/twc/articles/incorporating-specialized-lymphedema-therapy-wound-clinic. Fazzari E. A Collaborative Approach to Wound Care and Lymphedema Therapy: Part 1. Wound Care Advisor. 2015;4(3):30-32. Gethin G, Byrne D, Tierney S, Strapp H, Cowman, S. Prevalence of Lymphoedema and Quality of Life Among Patients Attending a Hospital-Based Wound management and Vascular Clinic. Int Wound J. 2012;9(2):120-215. Hettrick H. Why Every Wound Center Should Have a Lymphedema Specialist. Today’s Wound Clinic. Published October 2020. Accessed February 2, 2024. https://www.hmpgloballearningnetwork.com/site/twc/articles/why-every-wound-center-should-have-lymphedema-specialist. Keast D, Moffatt C, Janmohammad A. Lymphedema Impact and Prevalence International Study: The Canadian Data. Lymphatic Research and Biology. 2019;17(2): 78-186. doi:10.1089/lrb.2019.0014. Al-Gharibi K, Sharstha S, Al-Faras M. Cost-Effectiveness of Wound Care. Sultan Qaboos University Med J, 2018;18(4):433-439. doi:10.18295/SQUMI.2018.04.002. Lentz R, Shin C, Bloom Z, et al. From Bench to Bedside: The Role of a Multidisciplinary Approach to Treating Patients with Lymphedema. Lymphatic Research and Biology. 2021;19(1):11-16. doi:10.1089/lrb.2020.0118. Massimo R, Staines K. Cost Effectiveness of a Specialist Wound Care Service. Journal of Wound Care. 2021;30(9):685-692.