A Novel Approach in Meeting the Challenge of Chronic Lymphedema

A 54-year-old African American female with chronic bilateral lower extremity stage III Lymphedema and lymphorrhea presented to the outpatient rehabilitation wound care clinic (WCC) after a decade of ineffective treatment.  Her clinical presentation included immobility and decreased function secondary to severe lower extremity edema and uncontrolled wound exudate.  The patient was home bound due to lower extremity disfigurement and profound wound odor with resultant negative quality of life.

Previous treatment included diuretics, acute care hospitalization, and a prolonged long-term care stay for physical therapy and lymphedema treatment.  Plastics even suggested surgical debulking with skin grafting due to the severity of her condition.  The patient's refusal and request for a second opinion led her to a lymphedema specialist in the rehabilitation center.

It was observed that the traditional multi-layer short stretch lymphedema bandaging approach decreased her edema but not the copious drainage and severe maceration.  The outpatient wound team was consulted and a novel approach was applied with a successful outcome.  The approach included special skin cleansing, moisturization, two-step absorbent dressing treatment and the use of a four-layer bandaging compression system (which is traditionally used for venous insufficiency) applied two to three times a week. The several month treatment process resulted in significant leg size reduction, enhanced skin integrity, progressive ambulation, renewed socialization and improved quality of life.   Conclusions drawn from this case study have been shown to benefit other cases of stage III lymphedema in the wound care clinic.

Questions:

1.  Does the application of compression bandages aid in lymphedema treatment and lymphatic return?

2.  Is a multi 4-layer compression bandaging system superior to short stretch or lymphedema compression therapy?