LYMPHEDEMA WOUND TREATMENT AND CARE
Because of the serious complications that can arise from wounds, I cannot stress enough the need to understand wound care and treatment.
For current information, please see:
How to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
--------------------------------------
Here is an interesting article I ran across
about wound care
As the population ages, we develop disorders such as
lymphedema from previous cancer surgery or secondary
lymphedema
that result from
previous radiation treatment. The biggest challenge we see with
lymphedema and
wound healing relates to lymphedema of the lower legs. The average age
of
patients with chronic wounds for persons with diabetic foot problems is
about 60
and persons with venous leg ulcers is about 70 years old.
This challenge may also be from individuals with primary lymphedema or
persons
born with a propensity to develop increased swelling although this
swelling may
not be apparent at birth, it's often delayed into the teen years and
sometimes
even into adult life.
The third group we see, are those individuals with venous disease and
with
venous leg ulcers that are inadequately treated for years and develop
secondary
lymphedema to chronic venous disease. In this group, good preventative
measures
and good education would prevent the seondary lymphedema entirely!
Then there's a fourth group that relates to individuals who have
increased body
weight. In these individuals the venous return and the lymphatic return
to the
heart is obstructed so that lymphedema develops. This can be a vicious
cycle,
which requires working with the patient to control the weight problem.
The
influence of low albumin in wound healing
Having a low albumin can result in lymphedema. Albumin refers to the
protein
that circulates within the vascular system. One of the roles of the
albumin is
to keep this fluid within the vascular space. This is determined by how
much
albumin is in the blood. Normal albumin is greater than 30. When the
albumin is
under 25 you get some impairment in healing of chronic wounds. When
that number
is under 20 you don't have enough circulating protein within your
vascular
system and fluid tends to leak out of the vascular system. This taxes
the
lymphatics. If the lymphatics cannot handle the increased fluid
reserve, then it
stays in the tissue. This really sets
the stage for, first of all, pitting (finger imprint remains after
pressing on
the swelling) edema, and with time non-pitting edema, or lymphedema.
Preparing
the wound bed
Preparing the wound bed really starts with the patient. You must look
at
addressing the cause of the wound, but first you've got to remember
that you
have to treat the whole patient and not just the hole in the patient.
We also
have to look at patient centered concerns.
Compression therapy is important for lymphedema but there are pain and
quality
of life issues. Considerations include the warmth and the
uncomfortable nature of some of the bandaging and compression garments,
particularly during hot summers like the one we've just been through.
You've
also got to look at the patient's ability to buy bandages, stockings
and
lymphedema devices which may not be covered by health care or private
insurance
plans. These items can become very expensive so that individuals cannot
afford
them. Lymphedema sufferers can end up being fitted before the
edema comes under adequate control. When this happens individuals can
have a
custom made garment which costs a lot of money and might end up not
fitting them
when their pitting edema is controlled.
Although we have newer biological and adjunctive therapies, our
practice in
chronic wounds is not ideal. Our approach to chronic wounds includes
getting rid
of the grunge, looking at the excess bacteria that can sometimes creep
up on us,
and then examining moisture balance.
There are
three steps we should
look at in trying to adequately prepare
the wound bed for healing:
i) adjunctive therapies
ii) enzymatic therapies
iii) other interventions that help the wound to heal
i)
Adjunctive therapies:
The first step is debridement which is the removal of dead tissue. Dead
tissue
provides a wonderful growth media for bacteria. Dead tissue sitting on
the top
of the wound also stimulates an inflammatory response. A wound may get
stuck in
the inflammatory stage and not move along the ladder to the active
healing stage
so we have to get rid of that debris. Sometimes the debridement stage
is
performed surgically, other times it can be done with
dressings. Dressings that perform autolytic debridement ideally include
hydrogels and hydrocolloids. Examples of these might include Intrasite
and
duoderm gel as hydrogels and DuoDERM, Comfeel and Tegapore as
hydrocolloids.
Debridement can also be done through mechanical means such as a "wet to
dry" technique. "Wet to dry" to the lay person means putting
saline soaked gauze to the wound, letting it dry out and yanking it
off. It
causes pain, bleeding and is really not very patient friendly. It is
also very
nursing time intensive. This process can also be very damaging to the
wound
because it can leave pieces of gauze behind. It's an older method but
is still
widely used. One of the reasons it is widely used is because saline and
gauze is
cheap - but if you look at the nursing time involved it is not a very
good
treatment for modern medicine when we've got better techniques
available.
ii)
Enzymatic therapies:
There are enzymes available in Canada which can used to debride wounds.
Currently Collagenase (Santyl) is the only product available in Canada.
There
probably will be others in the future.
Sometimes the scab on the wound has to be scored with a blade by a
health
professional to facilitate penetration of enzymes to debride the wound.
A scab
is dead material and if it is completely necrotic it may be black and
hard. If
it has increased bacterial growth in it may have an odour.
Once the wound is debrided, the next issue is the bacterial balance. If
there's
loose slough, smell or very friable granulation tissue (which means it
bleeds
easily) it's a bright red and almost too good to be true, and the wound
stops
healing or it has an increased discharge: all of these signs may mean
the
surface of the wound has too many bacterial cells.
iii) Other
techniques:
Surgery is sometimes used to remove the dead material within a chronic
wound and
that is safe for people with lymphedema. One may have to use pain
medication
before surgery is done. Surgery to remove large areas of live
lymphedemtous skin
is usually frought with complications from recurring infections and
problems
controlling residual edema within surfaces which are irregular. For
this reason
it is not recommended at the present time.
Fungal/bacterial
situations:
To prevent fungal infections persons with lymphedema should inspect
their feet
particularly on a daily basis. That is to make sure their feet are dry
between
the toes. Fungal infections always start between the fourth and fifth
toe and
then spreads to the large toe because the fourth and fifth web space is
the
smallest space between the toes so that it gets the warmest and it
experiences
the most occlusion and friction.
What you first see in the toe web space is a white overly wet surface
scale that
we call maceration. Around the edge of that you may see a little rim of
scale
and may have an active margin. The other thing that may tip us off is a
foul
odour which usually means that anaerobic bacteria are present. And that
of
course can be an entry point for infection (cellulitis). Often
untreated
athletes' foot can be the source of recurring infection in the legs so
this is
really an important thing to pay attention to.
There are very good over the counter agents to treat this. Tenactin has
been
available since the 60's but it is much less effective than
Clotrimazole or
Miconazole which can be used to treat the fungus (70-80% effective).
When these
agents fail, Lamisil (terbinafine) is about 90% effective. The fungus
can also
involve the nails and the plantar skin of the feet. If it involves the
plantar
skin, you will see a white fine white powdery scale that goes around
the sides
of the feet. The involvement around the sides of the feet with a fine
red line
at the margin is often called a moccasin change to reflect the area
usually
covered by a moccasin. The fungal infection can also involve the nail
which
results in streaks starting distally. Nail fungus often starts
asymetrically and
then becomes symmetrical. With time the whole nail becomes thick and
sometimes
even destroyed.
Once you have nail involvement then you need a culture because nails
can be
abnormal simply with lymphedema by itself. Unless there is a culture
which shows
fungal filaments and/or the growth of the fungus, you should not use
oral
anti-fungal agents to treat nail abnormalities.
You should make sure your physician takes a culture before taking oral
Lamisil
which may be the preferred drug for fungal infections of the nail.
The health care professional has to check that there are no other drugs
you are
taking that might interact or change its effectiveness. Your doctor
should
probably do base line liver test although Lamisil only effects 1 in
10,000
people in terms of liver function abnormalities. Topical creams are
safe and
very few people react to them. Persons with lymphedema and anybody with
chronic
leg problems and ulcers should avoid substances that could cause
allergies. We
cause allergies in 50% to 70% of people with some products. The topical
antibacterial Neomicin should be
avoided which also cross sensitizes you and wipes out intravenous
Gentamicin and
a lot of very important systemic agents.
Maintaining the skin moisture balance Two things can be done to keeping
the
moisture balance in the skin. The stratum corneum (top layer of the
skin)
normally has about a 10% moisture content when it dips below 10%, you
start to
get dryness and flakes. Next you start to get the cracks and of course,
the
cracks or fissures, particularly in people with lymphedema, can be the
areas of
source of entry for the infection.
Dry skin should be monitored and watched very very carefully. In order
to treat
the cracks and fissures we can either lubricate, which is like putting
vaseline
or something oily on the surface and preventing insensible water
losses.
Alternatively we can put chemicals on the surface of the skin that
actually bind
water - and the two important ones are urea or lactic acid. They keep
the
stratum corneum moisture content for above 10%. Some of these
include: Uremol, Dermol therapy, Lachydrin lotion and Dermalac cream.
The most
important time to apply these is after bathing, padding off excess
moisture and
applying the cream while damp.
If you dry a wound/open skin sore out you get a California raisin. A
scab does
not promote cellular growth and healing. So that is why we look at
moist
interactive dressings. These include calcium alginates absorb a fair
bit and
also help with bleeding. Hydrogels and hydrocolloids are relatively
neutral and
for protection we use absorbant foams. Povidone-iodine, acetic acid,
hydrogen
peroxide and or Dakin's solution (sodium hypochlorite) should not be
used to
treat healing chronic wounds.
Patients should avoid any agent that contains lanolin, which is a low
sensitizer in normal people. It is a moderate sensitizer in people with
asthma,
hay fever and/or eczema and it is a high sensitizer for people with
chronic leg
problems. Over the counter products such as Keri Lotion act as
lubricants but
you have to be careful that they don't contain perfumes, which are
another
common sensitizer. Another major skin allergen is bacitracin which in
found in
Polysporin ointment but not polysporin cream. It often results in
contact
dermatitis. I don't recommend Neosporin because it has neomycin in it
and
neomycin is a common allergen.
Unfortunately in Canada there is no requirement to list ingredients in
these
products but it is compulsory in the United States. Many manufacturers
voluntarily put it on their label but not all. Patients need to be
informed
consumers when buying topical over the counter pharmaceuticals.
Home
remedies
Some patients use home remedies to reduce costs. Some are more
effective than
others. No product should be used without the knowledge and support of
your
doctor or specialist.
Bleach: Bleach is sodium hypochlorite. It's fine for your tabletop and
your
kitchen because it's a sanitizer. It's far too harsh and should not be
used on
skin since it can cause areas of breakdown.
Crisco: Crisco is an excellent lubricant, which has been used by
dermatologists
for very sensitive areas of the body. It has not shown any major
complications
as far as I am aware. Of home made remedies, this a better one.
Honey: Honey, of a commercial grade, can contain a certain number of
bacteria
that an individual could introduce into a wound including "botulism".
The honey that has been shown to be beneficial against some resistant
bacteria
is predominantly produced from the Manuka plant, which is native to New
Zealand,
and that is the Manuka honey. This product is not currently widely
available in
Canada.
The problem with the honey is that it really doesn't perform
autolytic debridement (clean the wound), it doesn't maintain moisture
balance and it may only superficially address the bacterial balance -it
does not
eliminate it, it just reduces their number. We have agents that do a
far better
job in preparing the wound than honey.
Tea tree oil: Tea tree oil is something that may have some
anti-bacterial and anti-fungal properties, but it is relatively
expensive and
can occasionally be an allergen. It has not really shown to address the
other
components in preparing the wound bed that we would like it to do.
Salt water: Salt water is simply saline. If you want to make your own
salt
water, that is fine as long as you don't dry the wound out. The new
modern
dressings really do better now. But you can make your own salt water by
putting
a teaspoon of salt in 8 ounces of water and micro waving it or boiling
it but
you have to remember that since the volume decreases with boiling it
might be
better to put your salt in after you boil it.
Baking soda: Baking soda is something that you can use to clean
clothing and
surfaces - but it is not recommended for the treatment of wounds. It
tends to be
slightly alkaline which promotes bacterial growth in chronic wounds
which can
delay healing, and it stings and burns. It would be better to use
dilute vinegar
which is more effective, but also often stings or burns.
Menstrual pads or diaper material as dressings: Menstrual pads or
diaper
material can be used as dressings on wounds - but individuals should
look at
some of the newer products out there before they use them. Non-sterile
dressings
can be bought in bulk at home health store or through a medical
supplier
reducing costs.
All chronic wounds contain bacteria. That bacteria is usually there as
a
contaminant or as a colonized bacteria that don't cause the wound any
harm. When
you go to buy gauze pads you don't need to buy the individual sterile
ones, you
can buy the bulk clean ones. The only exception is for somebody who is
immune
compromised through, for example, breast cancer operations,
chemotherapy or
radiotherapy treatment. In these situations sterile dressings are
recommended.
Appropriate use of antibiotics
There is a use and abuse of antibiotics. If there is a definite
infection - then
we have to use systemic antibiotics. If we don't use antibiotics, the
infection
can cause damage to the tissue which can make the lymphedema worse.
There are antibiotics that we use, long term in acne, that are equally
beneficial in lymphedema because these antibiotics also contain
anti-inflam
matory actions. The anti-inflammatory actions may help us in terms of
preventing
recurrent infections. Repeat infection cause even more damage to the
lymphatics
and more selling in the long term. If an individual has had two or
three
episodes of cellulitis in the past, using these long term - antibiotics
and
sometimes rotating them - is often useful. The drugs I am talking about
are
erythromycins, tetracyclines, trimethoprin and
clindamycin.
In selected situations we may use Bactroban which is very good for
Methicillin Resistant Staphylococcus Aureus (MRSA - resistant
pathogens/bacteria). But as soon as we get a lot of swelling, redness,
tenderness around a wound and pain, and especially if it probes to
bone, then
that requires oral or intravenous antibiotics and we're really looking
at
systemic agents to control infections. If there is an increased
discharge and
foul odour, antibiotics have to be used intermittently.
With pseudomonad bacteria, which can be common in people with
lymphedema, we
take a four-pronged approach: dilute white vinegar 1:5 or 1:10; topical
agents
such as silver sulfadiazine. The third step to use is oral agents such
as
ciprofloxicin. And when that fails we have to go to intervenous
antibiotics.
Future directionsWe are now moving into a high-tech age where genetic
research
may find the cause of many lymphedema related disorders. We may be able
to treat
lymphedema genetically through cellular or gene therapy!
We will likely have more biological agents to treat wounds more
effectively in
persons with lymphedema and we may be able to find what is missing in a
chronic
wound and what treatments will stimulate it to heal. This may be a way
to
deliver anti-bacterial agents.
Unfortunately it is going to take a long time to treat wounds that way.
In the
mean time we are going to have to develop better health care systems
which offer
improved diagnosis and treatment in this area. And access to the expert
clinics
to ensure that intervention for these problems occurs at an earlier
stage.
Dr. Gary Sibald
LYMPHOVENOUS CANADA
http://www.lymphovenous-canada.ca/dermatology.htm
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A PRACTICAL
GUIDE TO WOUND CARE
RNWeb® Archive
Jan. 1, 2000
A practical guide to wound care
JULIA THOMPSON, RN, BSN, CETN
JULIA THOMPSON is a wound and ostomy nurse at Scripps
Mercy Hospital in San Diego, Calif.
KEY WORDS: Wound care, assessment, documentation,
cleansing, dressings
Getting a wound to heal may well depend on your
ability to assess, clean, and dress it properly. In
this article, we cover the basic protocols for wound
care, along with the myriad dressings available today.
John Townsend is an 80-year-old incontinent patient
with a right, below-the-knee amputation, end-stage
renal disease, and Type 2 diabetes. He's brought to
your hospital from a local nursing home for a workup
of abdominal pain. During his initial assessment, a
dressing on his sacral area is removed, revealing a
stage III pressure ulcer.
If you were Mr. Townsend's nurse, would you know how
to care for his wound? It's a common one, to be sure,
but it can be perplexing to the nurse who doesn't have
a solid understanding of wound care. In fact, her
tendency might be to quickly reapply a dressing–any
dressing.
Knowing how to choose the right type of dressing is an
indispensable part of any wound care plan. So is
knowing how to clean a wound and how long to leave a
dressing on. This article, based in part on guidelines
from the Agency for Health Care Policy and Research,1
will discuss these care principles as they relate to
wounds in general.
Take a good look, then document what you see.
Effective wound care begins with an assessment of the
entire patient. On admission, get a complete health
history and do a thorough physical assessment.1 This
will help you identify the probable cause of the wound
and any contributing factors.
Next, examine the wound itself. Document its location
and size, noting its length, width, and depth in
centimeters. Also note the appearance of the wound bed
and surrounding skin. Check both for sinus tracts,
undermining, tunneling, exudate, drainage, necrotic
tissue, and signs of infection. You may also want to
photograph the wound if that's what your facility's
protocol dictates.
Document, too, how long the patient has had the wound.
Record any previous treatments and their results, and
whether the patient has any known allergies to wound
care products.
Based on Mr. Townsend's history and physical, you
determine that his pressure ulcer was probably caused
by a couple of factors. Since his amputation, he has
spent most of his time in bed or a wheelchair,
allowing pressure and shearing forces to break down
the skin on the sacrum. Also, because he has diabetes
and end-stage renal disease, you suspect he is
malnourished, a condition that contributes to skin
breakdown.
Mr. Townsend's physician orders a specialty support
surface designed to reduce pressure and shearing
forces. (We'll cover specialty mattresses and beds in
the Market Choices department in March and April.)
You'll plan to turn him every two hours and position
him on his side. You'll also submit a request for a
nutritional evaluation.
Your wound assessment shows Mr. Townsend's sacral
wound to be 4 cm long, 6 cm wide, and 2 cm deep. The
wound bed is composed primarily of beefy red
granulation tissue–a sign that the wound is trying to
heal itself–with some yellow slough at the base. There
is 2 cm of undermining around the entire circumference
of the wound. And, while there is a moderate amount of
exudate, there is no foul odor. The surrounding skin
is intact but fragile.
Mr. Townsend tells you that he developed the wound
about a month ago. He's not sure about past treatments
he received for it, and says he has no allergies.
If Mr. Townsend's wound had shown signs of local
infection–pain, foul drainage and odor, redness,
tenderness, swelling, and an abnormal firmness around
the wound edge and adjacent tissue–you would have
treated it with a topical antimicrobial such as silver
sulfadiazine (Silvadene).1 If he had had signs of a
widespread infection, such as sepsis or bacteremia or
cellulitis in the surrounding tissue, you would have
taken a culture–the results of which would be used to
choose an effective systemic antibiotic.
When performing a culture, it's important to use
proper technique. The book, Acute & Chronic Wounds:
Nursing Management, is a good resource on this
subject.2
Once you've assessed the wound and finished any
initial interventions, it's time to establish a local
wound care protocol. Depending on the facility, a
nurse may recommend a certain protocol to the
physician, who will then write the actual order. There
are four components: cleaning, dressing, determining
the frequency of dressing changes, and reevaluation.
Use the right cleanser at the right pressure
The goal of cleaning a wound is to remove dead tissue
and debris, which impede healing. You should use
products like sterile saline or a commercially
prepared non-cytotoxic wound cleanser like Comfeel
Sea-Clens (Coloplast Corporation, Marietta, Ga.) or
ClinsWound (Sage Laboratories, Inc., Shreveport, La.)
and wear a pair of protective goggles. Don't use
ordinary skin cleansers that are not FDA-approved for
open wounds. Antiseptics such as povidone iodine
(Betadine Antiseptic), sodium hypochlorite (Dakin's
solution), and hydrogen peroxide are not appropriate
for open wounds either; studies have shown that these
products are toxic to cells.1
If the wound has no necrotic (black) tissue or yellow
slough, use gentle pressure–about 4 to 5 psi–to clean
the wound. You can do this by applying the cleaning
fluid through a 60 ml catheter tip syringe. Pouring
the solution from a bottle or using a spray bottle or
bulb syringe may not provide enough pressure to do the
job.1
You will need to use more pressure to remove debris
from wounds with necrotic tissue and slough. You can
either place saline or a surfactant wound cleanser in
a 30 ml syringe and attach it to an 18- or 20-gauge
needle or use a pressurized irrigation system. (Saline
is also available in pressurized cans.) Whatever
device you use, just be sure not to deliver more than
15 psi. Doing so could traumatize tissue and drive
bacteria into the wound bed.1
Consider using a whirlpool treatment for wounds that
have a thick layer of exudate or slough.1 Position the
patient so that his wound is not directly in front of
the water jets. To prevent trauma to newly
regenerating skin, discontinue the whirlpool treatment
as soon as all debris is removed.
Whatever debris can't be removed during cleaning may
need to be removed with chemical or surgical
debridement.
Picking a dressing, evaluating your plan
After the wound is cleaned, you will need to dress it.
The box entitled, "Wound care dressings at a glance,"
lists 10 main categories of dressings along with
indications and nursing considerations. This month's
Market Choices department lists specific wound care
products and their features.
Most dressings are designed to maintain a moist–not
wet–wound bed, which has a number of advantages. It
enhances cellular activity in all phases of wound
repair. It facilitates autolytic debridement of
necrotic tissue. It enables epithelial cells to
migrate into the wound bed–something they can't do
when the bed is dry and crusty. And it insulates and
protects nerve endings, thereby reducing pain.
Moist healing does not promote infection. In fact, the
infection rate for all types of moisture-retentive
dressings is 2.5%, compared to 9% for dry dressings.3
Moisture does, however, make the skin more susceptible
to injury, so you may want to apply a skin sealant or
protectant to the skin around the wound before you
dress it to keep it dry. It is an especially good idea
when there is drainage or when the wound is located
near the perianal area of an incontinent patient. You
can also apply a skin sealant to fragile periwound
skin to keep it from tearing when you remove the
dressing.
Keep in mind that the moisture content of a wound can
vary as it heals. So it's not unusual for a wound to
need extra absorption at one point and then extra
moisture at another.
The schedule for dressing changes will depend, in
part, on exudate and drainage. In general, the more
exudate/drainage, the more frequent the dressing
change. The box entitled, "Wound care dressings at a
glance," provides a more specific timetable for each
type of dressing.
Assess and clean the wound bed at each dressing
change. Remember to follow basic infection control
measures to prevent cross-contamination. Thoroughly
wash your hands and change gloves between each patient
contact, for example.
You'll reevaluate the treatment protocol according to
the time frame set by your facility's policies and
procedures–earlier if there's an immediate problem,
such as the dressing becomes loose before its
scheduled change time.4 During reevaluation, don't
just measure the wound. Make sure you assess it to see
if it has improved. If not, you will need to consider
whether you have correctly identified all of the
causative factors and whether you need to change the
protocol.
Keep in mind that no wound care product can overcome
poor clinical practice. I've seen patients positioned
directly on their pressure ulcer! Practices like that
obviously negate any healing effects of the wound care
regimen.
A positive
outcome for our patient
When helping formulate a wound care protocol for Mr.
Townsend, you suggest to his physician that you use
sterile saline in a 60 ml catheter tip syringe for the
wound cleansing. Because his ulcer has moderate
exudate, you would like to use an alginate pad for his
primary dressing. A secondary dressing of transparent
film will hold the non-adhesive pad in place. A skin
sealant will help protect the fragile periwound skin
from fecal matter and tearing.
Because there is a moderate amount of exudate, a daily
dressing change is called for. The doctor approves of
the treatment plan and writes the order for it. You
will reevaluate it in a week.
In the meantime, Mr. Townsend's nutritional evaluation
confirms that he was not getting enough nutrients to
promote wound healing. So his doctor orders
supplemental oral feedings and a daily, high-potency
vitamin.
By the end of the first week, an increase in
granulation tissue and a decrease in slough are
evident. By day 14, healing has progressed, as
evidenced by a decrease in undermining to less than
1.5 cm and an increase in granulation tissue. You and
his other nurses continue the protocol. When Mr.
Townsend is discharged to his nursing home a few days
later, the wound is well on its way to complete
healing.
When any type of wound develops, it's a disheartening
experience for patients and staff alike. But with an
understanding of wound assessment, documentation, and
the components of a good care plan, nurses can make
the experience as short-lived as possible.
REFERENCES
1. Bergstrom, N., Bennett, M. A., et al. (1994).
Treatment of pressure ulcers: Clinical practice
guideline, No. 15. (AHCPR Publication No. 95-0652).
Rockville, MD: Agency for Health Care Policy and
Research, Public Health Service, U. S. Department of
Health and Human Services.
2. Bates-Jensen, B. (1998). Management of exudate and
infection. In C. Sussman & B. Bates-Jensen (Eds.),
Wound care: A collaborative practice manual for
physical therapists and nurses (pp. 165 – 166).
Gaithersburg, MD: Aspen Publishers.
3. Keast, D. H., & Orsted, H. (1998). The basic
principles of wound care. Ostomy and Wound Management,
44(8), 24.
4. Mulder, G. D., & Haberer, P. A. (Eds.). (1998).
Clinicians' pocket guide to chronic wound repair (4th
ed.). Bethlehem Pike, PA: Springhouse Corp.
SUGGESTED READING
Morison, M. (1997). A color guide to the nursing
management of wounds (2nd ed.). Prescott, AZ: Wolfe
Publishing.
......................
Signs of Wound Infection============External Links=======
Wound Care for Lymphedema (Study Course)
http://www.klosetraining.com/WoundCareforLymphedema.asp
Lymphedema: Skin and Wound Care in an Aging Population
http://www.o-wm.com/content/lymphedema-skin-and-wound-care-aging-population
==================================
Lymphedema Wounds Index of Articles
Hyperbaric Wound Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_hyperbaric_wound_trea.htm
Lymphorrhea
http://www.lymphedemapeople.com/thesite/lymphedema_lymphorrhea.htm
Lymphedema Wound Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_wound_treatment_and_care.htm
Wound Information
http://www.lymphedemapeople.com/thesite/lymphedema_wound_information.htm
Lymphedema Wound Links for Information
http://www.lymphedemapeople.com/thesite/lymphedema_wound_links_informati.htm
===========================
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
===========================
For information about Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\
For Information about Lymphedema Complications
http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema
For Lymphedema Personal Stories
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3
For information about How to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
For information about Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
For information about Exercises for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
For information on Infections Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
For information on Lymphedema in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphedema Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
===========================
Lymphedema People - Support Groups
-----------------------------------------------
Children
with Lymphedema
The time has come for families, parents, caregivers to have a support
group of
their own. Support group for parents, families and caregivers of
chilren with
lymphedema. Sharing information on coping, diagnosis, treatment and
prognosis.
Sponsored by Lymphedema People.
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
......................
Lipedema
Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
totally
frustrating conditions out there. This will be a support group for
those
suffering with lipedema/lipodema. A place for information, sharing
experiences,
exploring treatment options and coping.
Come join, be a part of the family!
http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515
Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com
......................
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved one with lymphedema who you are trying
to help
and understand come join us and discover what it is to be the master
instead of
the sufferer of lymphedema.
http://health.groups.yahoo.com/group/menwithlymphedema/
Subscribe: menwithlymphedema-subscribe@yahoogroups.com
......................
All
About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
http://health.groups.yahoo.com/group/allaboutlymphangiectasia/
Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com
......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
nothing out
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
perhaps,
it is time that one be offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
information
available through sister site Lymphedema People.
http://health.groups.yahoo.com/group/lymphaticdisorders/
Subscribe: lymphaticdisorders-subscribe@yahoogroups.com
===========================
Lymphedema People New Wiki Pages
Have
you seen our new
“Wiki” pages yet? Listed
below
are just a sample of the more than 140 pages now listed in our Wiki
section. We
are also working on hundred more.
Come
and take a stroll!
Lymphedema
Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema
Arm
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema
Leg
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema
Acute
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema
The
Lymphedema Diet
http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet
Exercises
for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
Diuretics
are not for
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema
Lymphedema
People Online
Support Groups
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups
Lipedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema
Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
Lymphedema
and Pain
Management
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management
Manual
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
Infections
Associated with
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
How
to Treat a Lymphedema
Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
Fungal
Infections Associated
with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema
Lymphedema
in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphoscintigraphy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Extraperitoneal
para-aortic lymph node dissection (EPLND)
Axillary
node biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy
Sentinel
Node Biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy
Small
Needle Biopsy - Fine Needle Aspiration
http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Lymphedema
Gene FOXC2
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2
Lymphedema Gene VEGFC
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc
Lymphedema Gene SOX18
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18
Lymphedema
and
Pregnancy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy
Home page: Lymphedema People
http://www.lymphedemapeople.com
Page Updated: Dec. 6, 2011