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How to Treat a Lymphedema Wound

Wound Care for Lymphedema Leaking Wounds

Everyone of us will from time to time get wounds on our lymphedema limbs. If your a clutz like me, you will get them from accidents.

They also may be caused by insects bites, such as ants or mosquitos.

More often however, there will be times when our skin just pops open and starts draining. When this happens, you must take care of the wound immediately. The fluid that seeps out will very quickly cause surrounding skin tissue to deteriorate and in no time that tiny wound can become a very serious problem.

Untreated wounds also leave a wide open entry foci for bacteria.

The resulting infections dramatically increase the severity of the lymphedema, can result in sepsis, gangrene, amputation or death.

Finally, it is important also to utilize the care of a wound treatment clinic if you continue to have problems with a wound healing or if any signs of complications and/or infections set in.

Related Wound Terms Terms

Wound Care, What is a Wound, Lymphedema Emergency Wound Kit, Treatment of Superficial Wounds on a Lymphodemous Limb, Contraindications in wound healing, Wound complications, Wound Classification, Hyperbaric Wound Treatment, Lymphorrhea, Wound Treatment

Pat

What is a Wound?

A wound is defined as any physical injury involving a break in the skin. For none lymphedema people generally wounds are caused by an act or accidently rather than a disease. These involve cutting yourself with a kitchen knife, stumbles and trips, falling, running into things, puncture wounds etc.

Lymphedema people however, experience wounds that are directly related to their medical condition. These are the weeping spots, the ulcerations, those areas where our skin just pops open. These will need to be treated differently than regular accident wounds.

Lymphedema Emergancy Wound Care Kit

Below is a supply list of basic first aid supplies I always keep on hand.

  • Tube of baby diaper rash creme or ointment, should have zinc
  • Tube of triple antibiotic ointment
  • Bottle of alcohol
  • Bottle of Normal Saline and/or
  • Sterile Water
  • Can of spray Wound Wash Saline
  • Roll of sterile gauze
  • Roll of paper nonallergan tape
  • Compression wrap that is only used to wound care
  • Sterile 3×3 (individually wrapped) gauze
  • Sterile 4×4 (individually wrapped) gauze
  • Extra roll or two of short stretch bandages

List of supplies never to use

Never use regular surgical tape on a lymphodemous leg

Never use regular bandaides because of the tape

Never use plastic tape of any kind

(Because of skin condition involved with lymphedema these would present further problems by damaging the skin)

Treatment of Superficial Wounds on a Lymphodemous Limb

I learned a wonderful technique from a wound clinic several years ago. This is excellent for superficial wounds.

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.

Contraindications in wound healing

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

Included in these contraindications are:

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

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.

Wound Classification

To understand wounds and how they might be treated, it is necessary to understand the various stages of classifications of wounds.

Class One Wound

Simple clean wound in the epidermal layer of the skin. In this stage there is no infection or inflammation. The wound is not invasive or traumatic and no other body systems are either afected or involved.

Lymphedema patients may easily with the correct techniques treat these wounds. However, if any sign of inflammation or infection, I strongly urge intervention by a medical professional.

Class Two Wound

The wound is still “clean.” Beginnings of inflammation or infection may be evident. It is critical that lymphedema patients consult and be supervised by a medical doctor. At this stage antibiotic therapy should be implemented.

At this stage the wound is contained in the epidermis or very slightly in the endodermis or dermis layer of the skin.

Treatment by primary care physician may be all that is required.

However with lymphedema, long standing wounds, even at this stage may call for treatment at a wound clinic.

Class Three Wound

This is a serious stage that generally will involve not only the epidermis, endodermis but the subcutaneous tissue as well. Wounds at this stage are generally caused by a serious or traumatic injury. Immediate care is critical to prevent further complications or infections.

At this stage it also may become important for referral to a wound treatment clinic.

Antibiotic treatment or therapy is mandatory.

Class Four Wound

In this class which involves deep long standing wounds, there is generally involvment of extensive infection and contamination. Wounds may be caused by extensive trauma or injury. Sepsis or septicemia is a real danger. Wound in this class may require extensive debridement and/or skin grafts for proper healing. There may be numerous complications you will experience with lymphedema. On this page I am going to list some of them. On our forums and other pages there will be additional information and links relating to each one in particular.

Wound Healing

The process of healing is slow and goes through several stages. The first stage is called the inflammatory, resting or lag phase because it appears that very little is happening. In fact this is a very active phase. It lasts several days.

The second stage, during which time the body is producing collagen to strengthen the wound, is called the metabolic phase and lasts several weeks. At this time, the body produces stronger, thicker scars than are ultimately needed.

The final stage of healing is the remodelling phase. It is during this time that the body refashions the scar and decides how much will remain.

These three stage have significance for the patient During the phase of inflammation the scar is not strong. The wound becomes increasingly red. The redness lasts through the active or metabolic stage. It is easy to confuse with infection because the scar is so red.

The redness does not begin to fade for at least six weeks after the operation or injury. It is at this stage that the scar is strong. In youngsters and those with fair skin the redness is often very prolonged and can last months. Some patients form a persistently heavy scar called a keloid.

Many factors can affect wound healing including diabetes, vitamin deficiencies and smoking.

A wound is not fully healed for one to two years. It is rare to revise or re-do scars until they are completely mature. http://www.phudson.com/OTHER/HEALING/healing.html

Signs of Wound Infection

  • 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.

Intermountain Healthcare

Signs of skin infection with a bruise/wound

Infection can develop after an injury or wound to the skin or mucous membranes (such as the inside of the nose or mouth), a bite or sting, a tattoo or piercing, or other skin problems. Signs of infection may include

  • Increased pain, swelling, redness, or warmth around the affected area.
  • Red streaks extending from the affected area.
  • Drainage of pus from the area.
  • Fever of 100 °F(37.8 °C) or higher, or chills with no other known cause.

Bruises usually do not become infected unless the skin was cut, punctured, or scraped. Most wounds will not become infected if they are properly cleaned and cared for. If you have a cut, puncture, or scrape, see the Home Treatment section of the topics Cuts, Puncture Wounds, or Scrapes, and follow the steps for cleaning and caring for a wound to reduce your risk of infection.

It is important to watch for signs of infection during the healing process. Wound infections are more likely to develop if

  • Blood collects in the wound (wound hematoma).
  • Dirt or objects, such as splinters, are left in the wound.
  • The wound is in an area of the body that has a lot of bacteria, such as the genital or anal area, skin folds, or web spaces of the toes.

Minor wound infections can lead to serious infections, such as

  • Infected (septic) hematomas.
  • Pus-filled pockets (abscesses) just under the skin surface or deep in tissue.
  • Bone infections (osteomyelitis).
  • Infections in or around a joint (infectious arthritis or septic bursitis).
  • Infections that affect the entire body (sepsis).

Prompt treatment of a wound infection can prevent serious complications.

WebMD

How to Clean a Wound During First Aid

All open wounds are contaminated to some extent and are potential sites for infection. The best way to prevent infection is to remove all debris from the wound and discourage further growth of bacteria.

Preparation

Steps:

Scrub hands thoroughly with soap and disinfected water.

Put on latex gloves to prevent the spread of infectious disease.

Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter disinfected water. See “How to Disinfect Water.” Set the disinfectant solution aside for about five minutes.

Tips and Warnings

You will need to have at least 1 liter of disinfectant solution on hand for this procedure.

Use a clear plastic bottle with measurements on the side, such as a Nalgene bottle, for easy measurement when mixing the disinfectant solution. These bottles include measurements in milliliters and ounces.

If povidone-iodine solution is not available, use disinfected water to cleanse the wound.

Infectious diseases such as AIDS and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing latex gloves. Wear goggles or glasses to protect against spurting blood or fluids. Wear a surgical mask to prevent the spread of other diseases. If you don't have gloves, a surgical mask and goggles, improvise by placing your hand in a plastic bag, wearing sunglasses, and covering your mouth with a bandanna.

Irrigation and Scrubbing

Step One Scrub the area around the wound using a nailbrush and disinfectant solution. Scrubbing may be painful to the injured person, but it is important that all debris is removed.

Step Two Sterilize a pair of tweezers using the disinfectant solution.

Step Three Remove all large pieces of dirt, debris, dead skin and flakes of clotted blood from the wound.

Step Four Draw the disinfectant solution into an irrigation syringe.

Step Five Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will flood the wound and drain away from the opening.

Step Six Press down on the plunger to emit a forceful stream of solution.

Step Seven Repeat the irrigation using 1/2 to 1 liter of solution. You may need to use more if the wound is especially dirty.

Step Eight Rinse the wound liberally with disinfected water, because the disinfectant solution may cause irritation to the skin if left on.

Step Nine Recheck the wound for bleeding; blood clots may have been dislodged. You may have to apply pressure to stop bleeding. See “How to Stop Mild Bleeding During First Aid.”

Step Ten Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, because this may cause burning.

Step Eleven Bandage the wound immediately after it has been thoroughly cleansed of all debris. See “How to Bandage a Wound During First Aid.”

Tips and Warnings

Irrigation syringes are also called pressure irrigators. If an irrigation syringe is not available, improvise by puncturing a plastic bag with a small hole, drilling or burning a hole into the top of a water bottle, or using a sports bottle with a squirting top. The idea here is to create a high-pressure flow of water, which will remove debris without damaging the tissue.

Do not use alcohol, iodine or mercurial solutions to cleanse a wound; these can damage the tissue. eHow

Call your family doctor if any of the following things occur in a wound

  • The wound is jagged
  • The wound is on your face
  • The edges of the cut gape open
  • The cut has dirt in it that won't come out
  • The cut becomes tender or inflamed
  • The cut drains a thick, creamy, grayish fluid
  • You start to run a temperature over 100°F
  • The area around the wound feels numb
  • You can't move comfortably
  • Red streaks form near the wound

The cut bleeds in spurts, blood soaks through the bandage or the bleeding doesn't stop after 10 minutes of firm, direct pressure

External Links

Wound Care – Types of Dressings

Canadian Association of Wound Care

The World Union of Wound Healing Societies

Wound Care Scientific Societies and groups

Wound Care Information Network

European Wound Management Association

Wound Care Information Network

Wound Care Discussion Forums

http://www.medicaledu.com/forum.htm

Electronic Journal of Wound Management Practice

Wound Care Society

Wound Management Association of Ireland

American Academy of Wound Management

LYMPHOVENOUS CANADA

Klose Training - Wound Care for Lymphedema

Lymphedema People Internal Links

Lymphedema People Resources

how_to_treat_a_lymphedema_wound.txt · Last modified: 2012/10/16 14:40 (external edit)