Lymphedema is an accumulation of protein rich fluid within the soft tissues. This fluid normally travels in fine channels known as lymphatics, which enter lymph nodes where filtration occurs. When these channels become blocked, the system is compromised and swelling results.
In the legs, chronic swelling is considered to be a combination of venous and lymphatic dysfunction (phlebolymphatic edema). This is present in patients with chronic venous insufficiency.
- Swelling of the leg
- Discomfort and “tightness”
- Frequent infections
- Cellulitis results from bacterial infection of the skin
- Lymphangitis results from infection in the lymphatics
Changes in the skin
- Inability to pinch or grasp the skin at the base of the second toe (Stemmer’s Sign)
Diminished quality of life
Today lymphedema can be treated effectively but early intervention is the key. Initially, therapy focuses on size and volume reduction. The second phase of treatment consists of patient education involving the application of wraps, devices and long-term maintenance.
Lymphedema and Venous Leg Ulcers
Venous leg ulcers occur in the portion of the leg covered by calf high socks. Most commonly from the ankle to the middle calf. These ulcers are generally moist, painless, “weep” and have debris present on their surface.
It is reported that 4.5 million Americans have venous leg ulcers. Patients with phlebolymphedema are more likely to develop cellulitis which can delay or prevent ulcer healing.
Studies have shown that unless the increased venous pressure (venous hypertension) as a result of venous insufficiency (reflux) is treated and the lymphedema effectively managed venous leg ulcers will not heal. Also, effective treatment will decrease the chances of forming new ulcers. Some believe treatment can heal existing ulcers more rapidly.