Guest Editorial: Global Efforts Address Wounds and Lymphedema

    Global awareness of the “hidden epidemic”¹ of lymphedema and chronic wounds was heralded by a wake-up call from the World Alliance of Wound and Lymphedema Care² (WAWLC). Worldwide, one person in 30 is estimated to suffer from lymphedema,¹ often with associated chronic wounds.

Lymphedema results from conditions as diverse as filariasis (23 million cases in India alone) or surgery involving lymphatic tissue (20% to 40% incidence following groin surgery).¹ Among persons older than 60 years, 1% to 3% are afflicted with chronic venous ulcers and edema resulting from venous insufficiency.³ Another 15% of 385 million people globally with diabetes⁴ are likely to develop at least one diabetic foot ulcer in their lifetime.¹ The magnitude of the global epidemic of other chronic wounds such as pressure ulcer ulcers and infected surgical or trauma wounds is only beginning to be appreciated and may be equally as large.

    For many conditions, lymphedema and wounds have mutual or related causes. Getting the diagnosis right, addressing the cause early, and managing the wound well can save limbs and lives. Historically, this doesn’t always happen because the pool of professional knowledge has been only isolated puddles. For the first time, professional knowledge and local knowledge are being integrated in a coordinated effort across diseases, professions, services, systems, and global nongovernmental volunteer organizations to address problems of wounds and lymphedema that have plagued mankind since the dawn of time.

    Interest was sparked in Accra, Ghana in July 2007 at the Lymphatic Filariasis Workshop on Disability Prevention for Field Managers, sponsored by Handicap International, where researchers, managers, and clinicians reported on lessons learned from their respective programs. Participants were encouraged by the World Health Organization (WHO)/AFRO Program Development Officer, Dr. Likezo Mubila, to explore strategies for the integration of care for a number of diseases to avoid duplication, maximize resources, and build synergy among stakeholders and governments. Wound and lymphedema management emerged as a common element of care that crossed all of these diseases and subsequently became the focus for training initiatives.

    In September 2007, the concept of implementing an integrated approach to wound and lymphedema care was presented by a group of international stakeholders to relevant WHO staff in Geneva. The WHO challenged participants to develop integrated disease-specific guidelines and corresponding training curricula adapted for different levels of healthcare systems within worldwide settings with limited resources. The first step toward accomplishing this goal has just been published by the WHO in the form of a 122-page volume, Wound and Lymphedema Management. The text was edited by John Macdonald and Mary Jo Geyer, with chapters by distinguished authors from around the world: T. J. Ryan, T. A. Treadwell, W.J. Ennis, R. G. Sibbald, H. L. Orsted, P. M. Coutts, D. H. Keast, L. L. Bolton, and R. S. Kirsner. Many of these authors share their hands-on experience managing chronic wounds and lymphedema in remote settings with limited resources. Permission to copy or translate this volume may be obtained from the WHO Press at permissions@WHO.Int. Hard copies can be obtained by contacting John Macdonald (trapparmac@aol.com).

    This volume succinctly focuses relevant best-available clinical evidence and principles on facing and resolving the global epidemic of lymphedema and wounds using locally available resources in disease-endemic countries, while recognizing that these principles are always improving. The volume is intended to serve as a clinical practice guideline for healthcare and nonhealthcare personnel, program developers and managers, and health and education policy makers involved in managing lymphedema and wounds. Clear, practical chapters contain a blend of knowledge, scientific evidence, and real-world experience in epidemiology, diagnosis, assessment, management, and prevention of major types of chronic wound and lymphedema conditions. Included are an indepth description of the role of compression and other interventions in lymphedema and chronic wound management and specific chapters dealing with infected wounds, pressure ulcers, venous ulcers, diabetic foot ulcers, and atypical wounds. Although recommendations on Buruli ulcers, leprosy, and lymphatic filariasis are addressed in more depth in other WHO publications and initiatives, this is the first WHO publication to integrate management of all wound and lymphedema conditions across environmental, professional, nonprofessional, and geopolitical boundaries.

    Publication of this volume is only the first step in integrating wound and lymphedema management across these boundaries. It brings a new unity of purpose. Inspired by common interest, a number of organizations involved in wound and lymphedema management have formed the WAWLC, working together to implement these principles with a single purpose: that patients may no longer hopelessly suffer from these conditions. Participating organizations include the Association for the Advancement of Wound Care, AMCICHAC (Mexico Wound Healing Society), Canadian Association of Wound Care, European Wound Management Association, Handicap International, Health Volunteers Overseas, Hôpitaux Universitaires de Genève, International Lymphedema Framework, International Society of Dermatology Task Force for Community Dermatology, International Society of Lymphology, Médcins sans Frontières, Netherlands Leprosy Relief, The Royal Tropical Institute of Amsterdam, and Wound Healing Association of Southern Africa. This publication and the implementation initiatives of the WAWLC offer new hope for resolution and renewed participation in life for wound and lymphedema patients formerly deemed beyond management. You can learn more about the WAWLC initiative and how international programs are working to improve patient outcomes in the March 2010 issue of WOUNDS.

    Now comes the hard task of working in teams to implement the few precious pearls we know and learning much more from each other: crossing boundaries of belief and territory; “experts” opening their minds to learn from success and failures; patients and caregivers opening their minds to effective caregiver and self-care options — all embracing the common goal of healing, bound by common knowledge, yet always searching for better, simpler, more patient-oriented ways to get the job done. Joined in common purpose, with unprecedented openness and sharing, the WAWLC is committed to apply this newly integrated knowledge as a stepping stone to improve wound and lymphedema outcomes around the world.