Quantitative study of the subcutaneous needle drainage of lymphoedema in advanced malignancy
Background: Lymphoedema is an often-neglected symptom of advanced malignancy. Subcutaneous needle drainage is a procedure that drains the fluid externally in refractory lymphoedema. It has the potential to improve quality of life but little objective data exist about its efficacy or adverse outcomes. This study used validated tools to objectively assess subcutaneous lymphoedema drainage. Methods: […]
Use of the HIVAMAT® 200 with manual lymphatic drainage in the management of lower-limb lymphoedema and lipoedema
Background: Manual lymphatic drainage (MLD) is a well-recognised and traditional treatment modality for oedema. HIVAMAT® 200 is a novel device that uses an intermittent electrostatic field to stimulate blood and lymphatic flow, thereby reducing oedema. This study aims to compare the effects of MLD alone to HIVAMAT® 200 plus MLD. Method: Three females with lipoedema […]
Wounds digest 9(1)
In this section, a brief synopsis is presented of a range of recently published articles that may be of interest to healthcare professionals working in the wound care setting. The aim of this round-up is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided […]
Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study
Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study
The story of my legs – a long and winding road to a good outcome
When I was younger, for many years I suffered all kinds of illnesses, including pneumonia, scarlet fever, diphtheria, mumps and tonsillitis. I never went to hospital — my mum cared for me at home. I think that is why my lymph nodes worked overtime; you can’t keep working at 100% all the time without some […]
Rising to the global challenge of wound care
The data are stark. The annual cost associated with treating and managing the wounds and comorbidities of 2.2mn patients within the NHS in the UK stood at £5.3bn in 2012/13, according to the Burden of Wounds study (Guest et al, 2015). On top of this, The prevalence of wounds has been estimated to be increasing […]
The use of compression wraps in the management of lymphoedema
There is increasing interest in the potential value of compression wraps in the management of lymphoedema and other disorders of the circulatory system. Given the significant unit cost of these materials, the All Wales Medical Devices Strategy Group commissioned an independent review of the literature to determine if these devices represent a cost-effective option for […]
Clinical innovation: the Sandy Grading System for Surgical Wound Dehiscence Classification — a new taxonomy
The worldwide volume of surgery is considerable, with an estimated 234.2mn major surgical procedures carried out every year (Weiser et al, 2008). While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence, although not commonplace, are a major disruptor to patient wellbeing and wound healing outcomes. Moreover, the importance of classification, documentation […]
Compression garments for managing lymphoedema
Lymphoedema is a chronic condition due to a compromised lymphatic system and results in the accumulation of oedema. It can affect patients who have undergone cancer treatments that involve removal of lymph nodes and radiotherapy. It can also present from a congenital defect of the lymphatic system and as a complication of a venous disorder […]
Top tips: skin and tissue trauma caused by self-harm
Patients who deliberately self-harm and cause skin and tissue trauma are increasing in number across primary and secondary care settings (Nice, 2011b). Self-harm has often been considered a taboo subject and an unnecessary burden to the NHS (Kilroy-Findley and Bateman, 2016). Despite the growing need for effective care, services for assessment, diagnosis and intervention are […]
Obesity-related lymphoedema and hospice charities: considerations for the future
The Leicestershire Organisation for the Relief of Suffering (LOROS), a hospice-based charity, runs a lymphoedema service and is facing an increase in the number of referrals for the treatment of obesity-related lymphoedema. This article highlights the issues involved and questions the appropriateness of providing treatment for this cohort of patients when the majority of funding […]
Oxygen therapies for wound healing: EWMA findings and recommendations
For wounds to heal, it is essential that macro- and microcirculation is restored in the surrounding tissue (Niinikoski et al, 1991; Gottrup, 2004a). One of the most urgent requirements is oxygen, as it is critically important for the reconstruction of new vessels and connective tissue, and also enables resistance to infection.
The adverse impact of strenuous exercise on breast cancer–related lymphoedema: a case report
Background: Exercise is an essential part of lymphoedema treatment; however, it’s important to consider the level of exercise intensity in lymphoedema patients. Aim: To examine the effects of one session of strong exercise, which included extreme weight-bearing to the limb affected by lymphoedema. Methods: A 66-year-old female patient with breast cancer–related lymphoedema (BCRL) attended the […]
Evaluation of the WIfI classification system in older patients with diabetes
In January 2014, the Society for Vascular Surgery published its new threatened limb classification system based on Wound extent, degree of Ischemia and foot Infection (WIfI). This classification represents a summary of multiple previously published classifications focused on diabetic foot ulcers and pure ischaemia or infection models. Despite the new system, patient-centred functional outcomes — […]
Our interest is swelling – but what’s in a name?
We seem to have made strides in our ability to differentiate between lipoedemas and myxoedemas on the basis of clinical testing and presentation, but there is still a lot of uncertainly it seems when it comes to defining the boundaries between chronic oedema and lymphoedema.
From the Lords to the wards
Wound care is a topic close to all of our hearts and so it was with great interest that I followed the debate in the UK House of Lords in November tabled by Lord Hunt of Kings Heath regarding what plans the UK government has to develop a strategy for improving the standards of wound care […]
The status of wound care units in Spain
The paucity of published studies to date has made it difficult to assess wound care provision in Spain. This paper reports the outcomes of the first census of units specialising in the treatment of chronic wounds in this country. Results indicate that wound units have very heterogeneous and diverse characteristics, varying according to region and […]
Links between BMI and the increasing incidence/prevalence of chronic oedema: what is our future?
There are five important points of note. Firstly, the prominence and importance of the lymphatic system has been elevated with the knowledge that it is the only path by which all that leaks out of the vascular system is returned to it. Secondly, we are facing a potentially massive epidemic of chronic oedema associated with […]
Skin tears: the underappreciated enemy of aging skin
The remarkable improvements in life expectancy over the past century have created a shift in the global population (World Health Organization [WHO], 2011). Globally, it is estimated that as aging populations increase in number, so too will the prevalence of chronic diseases (WHO, 2011). Caring for the aging population can be particularly challenging for clinicians […]
Patient education, self-care and medical grade honey – managing a diabetic ulcer
The prevalence of diabetes is rising globally with increasing budgetary burdens from the disease and its complications. In resource-limited environments, affordable treatment strategies are urgently needed. Wound care utilises diverse modalities, such as hydrogel, polyurethane and alginate dressings, as well as silver-containing agents. Honey is a well established treatment and is cost-effective. In a resource-limited […]
Abstracts from the 6th International Lymphoedema Framework Conference
The 2016 Asia Pacific Lymphology Conference is a product of a collaboration between the International Lymphoedema Framework and the Australasian Lymphology Association. It brings together delegates (including patients) from around the world, but with a focus on those from developed and developing nations from the Asia-Pacific region. The aim of the conference is to explore […]
Characteristics of intensive care unit (ICU) patients with pressure ulcers present on admission, acquired in ICU or no ulceration: a retrospective cohort study
A programme was initiated to study pressure ulcer (PU) risk factors in a large, mixed intensive care unit and to reduce intensive care-acquired PUs (ICaPUs). All adult patients treated in 2011–2015 (n=8,336) were included in this retrospective observational cohort study. The characteristics of patients with PUs present on admission, ICaPUs or no PUs were analysed. […]
Biofilm-based wound care with cadexomer iodine: Made Easy
A 62-year-old man presented with a left lower leg venous ulcer on the shin. The ulcer had high exudate levels, which was resulting in strike-through of dressings and there was some evidence of surrounding skin maceration. Investigations revealed an ankle brachial pressure index (ABPI) of 1.4. ALLEVYN◊ LIFE Non-Bordered foam dressing (Smith & Nephew) was […]
Does measuring blood pressure post-breast cancer surgical intervention increase the risk of developing ipsilateral arm lymphoedema?
Despite advances in our medical and surgical treatment modalities, and earlier detection, breast cancer surgery and/or radiotherapy remain the most common causes of secondary lymphoedema. Lymphoedema in the same arm that was exposed to the surgery/radiotherapy is referred to as breast cancer-related lymphoedema (BCRL). To date, the link between transiently compressing the at-risk arm and […]
Ten top tips: end of life pressure Injuries
Pressure injuries occur due to unrelieved or intense pressure in intolerant tissues. Perhaps, no patient exemplifies this risk as well as the end-of-life patient. Patients at end of their life are often malnourished, immobile, less cognitively intact, and incontinent, when they may have not been before. While most end-of-life patients are under the care of […]
Meeting report: antimicrobial stewardship in wound management
At the 27th conference of the European Wound Management Association (EWMA), which was held in Amsterdam on May 3–5, 2017, a joint symposium was held between EWMA and the British Society for Antimicrobial Chemotherapy. The symposium was organised into two sessions. The first focused specifically on wound care issues and the second concerned antimicrobial stewardship […]
Perceived barriers to adherence to breast cancer-related lymphoedema self-management
Background: Self-management is critical for the effective maintenance of breast-cancer related lymphoedema (BCRL), but levels of adherence are suboptimal. Aims: To compare the perceptions of lymphoedema therapists with those of women affected with BCRL regarding barriers to self-management. Methods: One-hundred-and-sixty-two women with breast cancer-related lymphoedema and 98 lymphoedema therapists were recruited. Participants completed an online […]
Managing inflammation by means of polymeric membrane dressings in pressure ulcer prevention
Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the […]
The rise of the robots and AI – their impact on lymphoedema diagnosis and treatment
We see automation and robots wherever we look and go — at the airport, in our cars and in our homes. Automation and robots are already in medicine being most prominent in the surgery area, but will they spread into the diagnosis and treatment arenas for lymphoedemas?
How can we know the true magnitude of any breast cancer-related lymphoedema if we do not know which is the true dominant arm?
Background: Patients with breast cancer tend to limit the use of their arm which may result in muscle reduction and misdiagnosis of breast cancer-related lymphoedema (BCRL). Aims: To examine whether patient-reported arm dominance matched the true dominant arm and if the side of surgery had an impact on grip strength and BCRL. Methods: Grip strength […]
Assessment and consideration of foot risk factors is essential for proactive prevention of hospital-acquired foot pressure injuries
The research outlined in this article aimed to see if high-risk feet were also identified as ‘at risk of ulceration’ by the Braden Score. One-hundred-and-thirty-two patients had foot risk stratified by a podiatrist and their admission Braden pressure injury (PI) risk level was compared. Only 36% were decreed to be at the same level of […]
The lymphatic system and skin conditions, old age and the impact of medications
Here, the editor answers some readers’ questions and invites you to share thoughts and experiences
Novel body-weight device for compression garment donning in lymphoedema treatment
Background: Lymphoedema is commonly treated using complex decongestive therapy followed by the application of compression garments. These elastic garments are often difficult to pull over the enlarged limb. Aim: To design and build a novel device to assist with the donning of compression garments in a clinic and assess its use in practice. Method: The […]
From the Lords to the wards
Wound care is a topic close to all of our hearts and so it was with great interest that I followed the debate in the UK House of Lords in November tabled by Lord Hunt of Kings Heath regarding what plans the UK government has to develop a strategy for improving the standards of wound care […]
Skin tears: the underappreciated enemy of aging skin
<p>The remarkable improvements in life expectancy over the past century have created a shift in the global population (World Health Organization [WHO], 2011). Globally, it is estimated that as aging populations increase in number, so too will the prevalence of chronic diseases (WHO, 2011). Caring for the aging population can be particularly challenging for clinicians […]
Characteristics of intensive care unit (ICU) patients with pressure ulcers present on admission, acquired in ICU or no ulceration: a retrospective cohort study
<p>A programme was initiated to study pressure ulcer (PU) risk factors in a large, mixed intensive care unit and to reduce intensive care-acquired PUs (ICaPUs). All adult patients treated in 2011–2015 (n=8,336) were included in this retrospective observational cohort study. The characteristics of patients with PUs present on admission, ICaPUs or no PUs were analysed. […]
Ten top tips: end of life pressure Injuries
<p>Pressure injuries occur due to unrelieved or intense pressure in intolerant tissues. Perhaps, no patient exemplifies this risk as well as the end-of-life patient. Patients at end of their life are often malnourished, immobile, less cognitively intact, and incontinent, when they may have not been before. While most end-of-life patients are under the care of hospice […]
Managing inflammation by means of polymeric membrane dressings in pressure ulcer prevention
<p>Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the […]
Assessment and consideration of foot risk factors is essential for proactive prevention of hospital-acquired foot pressure injuries
<p>The research outlined in this article aimed to see if high-risk feet were also identified as ‘at risk of ulceration’ by the Braden Score. One-hundred-and-thirty-two patients had foot risk stratified by a podiatrist and their admission Braden pressure injury (PI) risk level was compared. Only 36% were decreed to be at the same level of […]
Amit Jain’s Triple Assessment of Foot in Diabetes — a rapid screening tool
<p>Diabetic foot is on the increase with prevalence rates of diabetes growing around the world. In spite of this, it is frequently a neglected entity in many countries. Screening of the diabetic foot serves to identify any underlying problem and helps one to immediately institute preventive and therapeutic measures. There are few screening tools currently […]
The use of Prontosan® in combination with Askina® Calgitrol®: an independent case series
<p>Many patients with chronic wounds will develop infection (Landis et al, 2007; Sibbald et al, 2011). Worldwide consensus on the specific use of silver antimicrobials recommends that silver dressings should be used initially for a ‘two-week challenge’ (Wounds International, 2012). Sixteen different individual case studies were carried out to evaluate the efficacy of a biofilm remover/cleanser […]
Meeting Report: 'Raising the Bar'- creating a better tomorrow
<p>This article is based on the proceedings of the one-day ‘Raising the Bar’ conference in Singapore held by Wounds International and supported by an educational grant from Urgo International on October 15, 2017. The day provided more than 100 clinicians from around Asia with an exceptional opportunity to gain insights and best practice recommendations from […]
Wounds digest 9(1)
<p>In this section, a brief synopsis is presented of a range of recently published articles that may be of interest to healthcare professionals working in the wound care setting. The aim of this round-up is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided […]
Surgical wound dehiscence: Improving prevention and outcomes
Surgical wound dehiscence (SWD) is almost certainly under-reported, not least because of variation in the interpretation of what constitutes SWD. As a result, patients with SWD may not receive optimal treatment and may experience additional surgical site complications, increased mortality, prolonged hospital stays and readmission. Following a meeting in July 2017, an international panel of […]
Consensus document: Surgical wound dehiscence: Improving prevention and outcomes
Surgical wound dehiscence (SWD) is almost certainly under-reported, not least because of variation in the interpretation of what constitutes SWD. As a result, patients with SWD may not receive optimal treatment and may experience additional surgical site complications, increased mortality, prolonged hospital stays and readmission. Following a meeting in July 2017, an international panel of […]
Case studies evaluation: TIELLE Foam Dressings in practice
This International Case Study Evaluation presents ten case studies from Germany, Holland, Republic of Ireland and South Africa, which illustrate use of the TIELLE Foam Dressings range in practice in different aetiologies, including ulcerations, traumatic wounds and post-surgical wounds, in a variety of settings and across various disciplines. Supported by KCI – An Acelity Company
SEM Scanner Made Easy
It is well documented that early diagnosis and intervention may contribute to pressure ulcer prevention, which is less costly that treatment. This Made Easy provides an overview of the SEM Scanner, a diagnostic tool that allows the user to ‘visualise pathology’ below the skin before changes manifest at the surface, allowing preventative strategies to be […]
3M™ Snap™ Therapy System
This Quick Guide outlines the 3M™ Snap™ Therapy System, a wearable device that combines the benefits of negative pressure wound therapy (NPWT) with advanced wound dressings. Supported by 3M
The role of mechanically powered disposable negative pressure wound therapy(dNPWT) in practice
This consensus document provides clinicians with guidance to decision-making within the changing landscape of negative pressure wound therapy (NPWT), with a focus on using disposable NPWT (dNPWT) devices in practice. Supported by KCI – An Acelity Company
Local management of Diabetic foot ulcers
The management of diabetic foot ulcers is complex, and requires a multi-disciplinary team approach to avoid serious and expensive complications, such as infection and amputation. This Quick Guide outlines the principles of local management and practice. Supported by Acelity
