Managing ulceration and lymphorrhea in chronic oedema

Hydration response technology dressings for low to excessively exuding wounds: a systematic review

OBJECTIVE

The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate.

METHOD

A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included.

RESULTS

The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy).

CONCLUSION

The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.

Lymphovenous Anastomosis for Morbidly Obese Patients with Lymphedema

Although patients with obesity-induced lymphedema can be treated by weight loss therapy, they find it difficult to lose the required amount of weight. The aims of this study were to clarify the characteristics of the lymphatic vessels in patients with obesity-induced lymphedema and to determine the feasibility and efficacy of lymphovenous anastomosis (LVA) in these patients.

Methods

Twenty-two patients (44 edematous lower limbs) with a body mass index (BMI) >35 kg/m² (obese group) and 91 patients with lymphedema (141 edematous lower limbs) and BMI <25 kg/m² were enrolled as a control group (nonobese group) and underwent LVA. The diameter and depth of lymphatics and the effect of LVA were compared.

Results

Lymphatics were detectable within 10-mm depth in the nonobese group and the obese group (3.0 ± 1.4 mm versus 3.5 ± 2.1 mm; P < 0.01). The lymphatic diameter was significantly greater in the obese group than in the nonobese group (0.79 ± 0.30 mm versus 0.54 ± 0.22 mm; P < 0.01). There was no significant difference in the rate of improvement in lymphedema after LVA between the nonobese group (9.1% ± 9.2%) and the obese group (8.9% ± 7.3%; P = 0.84). There was no correlation between the improvement rate of lymphedema and that of BMI in the obese group (P = 0.57).

Conclusions

LVA is a feasible procedure even in morbidly obese patients. Considering that substantial weight loss is a difficult and time-consuming task for patients, LVA combined with not gaining weight is a good option for these patients.

Outcomes of a new wrap compression system for patients with lower limb ulceration and oedema

JOBST® FarrowWrap® is indicated in patients presenting with venous leg ulceration in combination with mild-to-moderate oedema. These symptoms result in significant physical and psychological problems and management can be costly in terms of duration of input and resources. This article will present four case studies demonstrating the benefits and outcomes for patients with lower limb issues and will consider how the product helps improve shape, reduce oedema, heal ulceration, improve quality of life in relation to the lower limb and encourage self-care.