The awareness, diagnosis and management of chronic oedema and lymphoedema is improving. The enduring treatment format for the condition has always been regarded as the 'four cornerstones' of care for maintenance therapy in the UK. However, with changes in technology, availability of additional treatments and increased research and studies, this baseline is changing. This article outlines some of the recent changes and advancement in diagnostic tools and new technologies used in diagnosing and managing lymphoedema and chronic oedema. Emerging therapies will be introduced, as will other aspects of care that may now be considered 'essential care' in the management of lymphoedema and chronic oedema.
KEY WOrDsw Lymphoedema w Essential care w Advanced assessment
The purpose of this article is to discuss the use of custom made compression garments in the management of lymphoedema and chronic oedema. Patients often present to therapists with inappropriate, ill-fitting garments that can contribute to an increase in oedema and poor limb shape. Patients frequently report garments as being uncomfortable and therefore intolerable leading to a lack of concordance with wearing garments. The selection and fitting of the correct garment can affect outcomes and the patients' quality of life. The focus of this article is to increase the health professionals' knowledge and skills in the selection, measurement and fitting of custom made garments to ensure correct fit and increased concordance when compression garments are prescribed. KEY WORDS Chronic oedema w lymphoedema w flat knit compression garments w static stiffness
The use of FarrowWrap™ as an alternative to multilayer lymphoedema bandaging (MLLB) can provide an efficient, cost-effective treatment for patients with all types of chronic and lymphoedema oedema. In addition, used within supervised self-management, it allows for the patient to gain control and confidence of their long-term condition, giving greater independence. This article discusses the theory of MLLB and introduces FarrowWrap, an alternative wrapping system offering flexible compression treatment for a range of oedemas. Case studies are included to illustrate varied uses of FarrowWrap and how it can be implemented into clinical practice.
Lymphoedema management has evolved over many decades, but the core components of treatment remain largely unaltered, such as skin care, compression and self-lymphatic drainage. Near-infrared fluorescence lymphatic imaging (NIRFLI) offers an opportunity to enhance patient outcomes by evaluating and increasing the effectiveness of these treatment options. This is relevant when we consider the impact of this chronic condition and its endemic proportions ( Mortimer, 2014 ), while Moffatt et al (2017) suggests it is one of the biggest health risks in the Western world, due to the multiple causes, such as cancer, obesity and as a complication of an ageing population. The impact of the condition can be reduced through early identification and the risk-reduction strategies that NIRFLI can offer through greater understanding of its chronicity. The use of NIRFLI has also led to the development of a new manual lymphatic drainage technique to assist in the management of lymphoedema ( Belgrado et al, 2016 ). The aim of this article is to introduce and describe NIRFLI and its use within lymphoedema management. It will discuss use with early detection of lymphoedema and expand further, focusing on its use within the management of lymphoedema.
Compression garments have been widely used in the management of lymphoedema and form part of the maintenance phase of treatment. Maintenance therapy usually consists of skincare, exercise, self lymphatic drainage
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