Wound Bandaging for a Lymphedema Limb

Weeping spots, lymphorrhea, Cuts, Scrapes, Stitches, Blisters, Silver Dressings, Compression therapy, wound bandaging, wound infections

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Wound Bandaging for a Lymphedema Limb

Postby patoco » Fri Jul 07, 2006 11:17 pm

Wound Bandaging for a Lymphedema Limb

Lymphedema People

http://www.lymphedemapeople.com

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For extended information on wounds, please "click" on the Wounds section on the left topical index

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Everyone of us from time to time experiences those open "sores" or blisters on either our arms or legs. With lymphedema, it is important to understand the difference in wound care that is needed for these limbs versus standard wound care for a non-lymphedema limb.

In addition to bandaging the wound, a compression wrap is also essential for wound healing.

There are a couple reasons for this:

1.) Unwrapped, the limb will swell, usually more then normal. A wound the is trying to heal has the tissues pulled apart with swelling. Thus, it is unable to close.

2.) Compression is also needed to stop the leakage of the fluid in our legs, called lymphorrhea. This protein rich liquid causes further damage to the surrounding skin and will usually lead to a larger, much more complicated wound.

With the lymphedema patient, wound care is more difficult and presents a greater challange that with a normal lymph flow limb.

Contraindications in wound healing with lymphedema:

Lymphorrhea - very caustic and destructive fluid weeping from the wound. The fluid causes further destruction of the skin and is a major impediment to healing.

Infection - always a threat to lymphedema patients. Invasive bacteria can lead to serious infections, cellulitis, lymphangitis, erysipelas and even sepsis and gangrene.

Localized Immunodificiency - The affected limb is simply not able to fight the infections that may be present. Antibiotic therapy is necessary.

Tissue quality and fibrosis - Fibrotic tissue simply does not heal as normal tissue. Wound treatment may require extended therapy.

Impaired vascular flow - In late stage lymphedema, the blood flow may be impaired, preventing nutrients and needed oxygenation to the wound.

Swelling - Compression bandages are required to prevent further swelling of the limb. Swelling not only "pulls" apart tissue that is attempting to heal, but causes further drainage of lymphorrhea.

Wound complications with lymphedema:

This list of wound complications is actually very simple:

1. Infections, cellulitis, lymphangitis, erysipelas
2. Systemic infections, septicemea
3. Necrosis and gangrene
4. Amputation
5. Death

If you have any type of wound, immediate care is required.

Signs your wound may be infected:

Pus or cloudy fluid draining from the wound.
Pimple or yellow crust formed on the wound (impetigo).
Scab has increased in size.
Increasing redness around the wound (cellulitis).
Red streak is spreading from the wound toward the heart (lymphangitis).
Wound has become extremely tender.
Pain or swelling increasing after 48 hours since the wound occurred.
Wound has developed blisters or black dead tissue (gangrene and myonecrosis).
Lymph node draining that area of skin may become large and tender (lymphadenitis).
Onset of widespread bright red.
Onset of fever.
Wound hasn't healed within 10 days after the injury.

For those simple open, draining areas we all experience, I use this technique for bandaging:

I use a very simply, but effective ointment. Desitin with zinc,
thats right baby diaper ointment.

Cover the wound with ointment and place several pieces of square gauze over it. Wrap the affected part of the limb with rolled gauze and then wrap around that with an elastic bandage. Wrap firm but not over tight, using a criss cross method (figure eight).

NOTE: This is for superficial wounds only. If the wound does not clear up within a few days, consult your doctor. You must also see your doctor immediately if it is a large wound or injury or if there begins to be inflammation or infection.

Sometimes, you may even need to go to a Wound Clinic. I have found them to be wonderful and very helpful.

When to call the doctor: For any other cuts, punctures, scraps or abrasions.

It is important to remember also, that because of the possibility of infection, it may be necessary for you to be on antibiotics. Discuss this with your physcian.

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Cleaning and Bandaging a Wound

Topic Overview

Skin wounds need to be thoroughly cleaned as soon as possible to reduce the risk of infection and scarring and to promote healing.

If the wound is large, deep, too painful to clean, or has dirt, debris, or a foreign object in it that you cannot remove, see a health professional.

Stop the bleeding

Before you clean the wound, try to the stop the bleeding.

Put on medical gloves, if available, before applying direct pressure to the wound. If gloves are not available, use many layers of clean cloth, plastic bags, or the cleanest material available between your hands and the wound.

Hold direct pressure on the wound, if possible, and elevate the injured area.

Use your bare hands to apply direct pressure only as a last resort.
Remove or cut clothing from around the wound. Remove any jewelry from the general area of the wound so if the area swells, the jewelry will not affect blood flow.

Apply steady direct pressure for a full 15 minutes. Use a clock—15 minutes can seem like a long time. Resist the urge to peek after a few minutes to see whether bleeding has stopped. If blood soaks through the cloth, apply another one without lifting the first. If there is an object in the wound, apply pressure around the object, not directly over it.

Clean the wound

If you are not going to see your health professional immediately, rinse the wound for at least 5 to 10 minutes.

Minor wounds

Wash your hands well with soap and water, if available.

Put on medical gloves before cleaning the wound, if available.

Remove large pieces of dirt or other debris from the wound with cleaned tweezers. Do not push the tweezers deeply into the wound.

Wash the wound under running tap water (the more the better) to remove all the dirt, debris, and bacteria from the wound. Lukewarm water and mild soap, such as Ivory dishwashing soap, are the best. (Note: If you are cleaning a wound near the eye, do not get soap in the eye.)

Scrub gently with a washcloth. (Moderate scrubbing may be needed if the wound is very dirty.) Hard scrubbing may actually cause more damage to the tissue and increase the chance of infection. Scrubbing the wound will probably hurt and may increase bleeding, but it is necessary to clean the wound thoroughly.

If you have a water sprayer in your kitchen sink, try using the sprayer to wash the wound. This usually removes most of the dirt and other objects from the wound. Avoid getting any spray from the wound into your eyes.
Large minor dirty wounds may be easier to clean in the shower.
If some dirt or other debris remains in the wound, repeat the cleaning.

Large, deep, or dirty wounds

You may need to see a health professional for a large, deep, or very dirty wound to determine whether you need stitches or antibiotics. Most wounds that need stitches should be treated within 6 to 8 hours after the injury to reduce the risk of infection. Very dirty wounds may not be stitched to avoid the risk of infection.

If you are going to see a health professional immediately, the wound can be cleaned and treated at the medical facility.

Bandage the wound

Thoroughly clean the wound before bandaging.

Use of an antibiotic ointment has not been shown to affect healing. If you choose to use an antibiotic ointment, such as polymyxin B sulfate (for example, Polysporin) or bacitracin, apply the ointment lightly. The ointment will keep the bandage from sticking to the wound. Be sure to read the product label about skin sensitivity. If a skin rash or itching develops under the bandage, stop using the ointment.

Apply a clean bandage when it gets wet or soiled to further help prevent infection. If a bandage is stuck to a scab, soak it in warm water to soften the scab and make the bandage easier to remove. If available, use a nonstick dressing.

If needed, use an adhesive strip called a butterfly bandage to hold the edges of the wound together. You can make one at home or buy them already made. Always put the butterfly bandage across a cut, not lengthwise, to hold the edges together.

Take the dressing off and leave it off whenever you are sure the wound will not become irritated or dirty.

When to get stitches

A quick test to determine whether you need stitches is to wash the wound well and stop the bleeding, then pinch the sides of the wound together. If the edges of the wound come together and it looks better, you may want to consider getting stitches. If stitches may be needed, avoid using an antiseptic or antibiotic ointment until after a health professional has examined the wound.

Wounds that are at high risk of infection, such as dirty cuts or crush injuries, are usually closed within 6 hours after the injury. Occasionally a wound that is at high risk of infection will not be stitched until after 24 hours, or may not be stitched at all, so that adequate cleaning and antibiotic treatment can be done initially to prevent infection.

A cut with a clean object, such as clean kitchen knife, may be stitched from 12 to 24 hours after the injury depending on the location of the cut.

A clean facial wound in a healthy person is at low risk of infection and can be stitched up to 24 hours after the injury. Stitching may be done for cosmetic appearance to reduce scarring.

** Editor's note Stitches in a lim effected by lymphedema can be difficult to manage. As the limbs swells, the stitches may become "imbedded" in the skin tissue. Discuss with your doctor the possibility of alternatives such as skin glue or depending on the wound cauterizing it. That has been very successful for me for biopsies done on my late stage 3/stage 4 left leg**

Credits
Author Ellie Rodgers
Editor Geri Metzger
Associate Editor Lila Havens
Primary Medical Reviewer Adam Husney, MD
- Family Medicine

Last Updated October 12, 2004

http://www.sjmercyhealth.org/12945.cfm
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