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HYDROMECHANICS OF TISSUE EDEMA FLUID UNDER COMPRESSION BANDAGES
ZALESKA M., OLSZEWSKI W. L.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Background: Bandaging is an intergral part of complex decongestive therapy of lymphedema. The conditions effective bandaging should meet are: generating tissue fluid (TF) pressures high enough to mobilize and propel fluid and maintain the on-limb elasticity of bandage material for hours, both at rest and during muscle contractions. How high is the TF pressure at the site of application of bandages remains unknown. Moreover, it is unknown how much fluid moves proximally after applying bandage compression.
Aim: To measure simultaneously the subcutaneous TF and bandage-skin interface pressure, as well as TF flow after application of bandages, with increasing compression force.
Methods: Twenty patients with lymphedema of lower limb stage II were investigated. Bandage-skin interface and TF pressures were measured after application of one and two layers of elastic or short-stretch bandages. TF flow wasmeasured during bandaging with plethysmography.
Results: TF pressures generated by bandaging were lower than those at the bandage-skin interface. The difference ranged from 10 mmHg in soft to 30 mmHg in cases with hard skin. Two layer bandaging maintainedstable TF pressures. Muscle contractions generated TF amplitude only up to 10 mmHg. There was a continuous drop of TF pressure due to evacuation of TF, more evident under short-stretch bandage. Flow volume depended on the TF pressure level, being lower in limbs with hard skin.
Conclusions: To obtain effective TF pressures generating flow, external pressures by bandaging should be set at the bandage-skin interface of around 60 or more mmHg.
THE RIGHT TREATMENT OF LYMPHANGITIS: FROM EARLY DIAGNOSIS WITH SPECIFIC CLINICAL SCORE TO A CORRECT SHORT STRECTH BANDAGE ALSO WITH NEW MANUKA HONEY DRESSING
ALBERTO MACCIÒ 1, FRANCESCO BOCCARDO 2, GIOVANNA CAVALLERO, SALVATORE GERMANO, CORRADINO CAMPISI 2
1 Italian Lymphological Center, ICC member, Italy
2 IRCCS University Hospital San Martino - IST National Institute of Cancer Research, Genoa, Italy
The septic complication of chronic lymphostasis also known as lyphangitis is very frequent in daily practice of Clinical Lymphologist. With the Stewart-Treves Syndrome (Lymphangiosarcoma), the infection in patients with diseases connected to insufficiency of lymphatic circulation represents the principal life-threatening problems in our therapeutic approach.
In this paper, we will show you our specific experience about the early diagnosis and the proper treatment of the lymphangitis.
As we know, the primary and secondary prevention of microbial infection is a first and fundamental step in reducing the recurrences of the septic complication in chronic lymphostasis like decreasing the risk factors. In any case, the number of these relapses is increasing today in the same way as the prevalence of lymphatic diseases in the world.
We have estimated almost 1% of the patients who are accepted in the emergency room showing signs and symptoms related to the potential infection with primary involvement of lymphatic circulation.
For these cases we use the Lymphangitis score to recognize very early the high risk of infection overall in chronic lymphedema patients. From our experience, after evaluating more than 300 non traumatic acute diseases we have seen a very high sensibility
(> 99%) of this test versus a good specificity value (94%).
Once the complication is suspected the therapy should have two principal approaches. First is the prescription of systemic antibiotics, broad spectrum or guided by clinical signs. The second approach is using the appropriate short stretch bandages of the limb with zinc oxide or new manuka honey dressings to reduce the edema and improve the peripheral lymph flow. In our presentation, we will show you both procedures which include the protocol for choosing an antibiotic and the correct pressure when applying the bandages. Estimating correctly the lymphangitis complication and the early treatments to be taken are the most important things to help the patients with chronic lymphatic diseases.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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