Redefining essential care in lymphoedema

Abstract

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

A review of the evidence for adjustable compression wrap devices

“…15 A more substantial series of descriptive papers has discussed the FarrowWrap system for lymphoedema, originally brought to the UK market by Haddenham Healthcare. 11,[16][17][18][19] FarrowWrap is an adjustable hook and loop fastener system with multiple overlapping neoprene bands, interconnected by a spine. A case study described its' use in a young women with low mood who was not keen to have intensive bandaging treatment.…”

“…16 Hobday and Wigg 19 describe the product as encouraging practitioners to take a creative, problem-solving approach to care, working in partnership with the patient. Both devices are reported as versatile and easily adjusted to a change in limb size to enable self-management of oedema reduction 10,18 , while also allowing for skin care to be carried out on a regular basis. 19 FarrowWrap has also been suggested as a useful garment for night use and compared favourably to short stretch bandaging 20 , although research evidence is lacking and the above papers are all descriptive in nature with only two research studies identified.…”

“…38 Several papers and posters suggested that self-care adjustable compression wrap devices provide cost savings associated with reduced use of bandaging materials, time saved due to quicker and easier application of the devices, application by the person or their carer, and fewer nurse visits or appointments for bandaging. 18,28,34,35 Further economic advantages are also identified as the adjustable compression wrap devices can be washed, and reused over a period of 6 months, providing a cheaper option than repeated bandaging.…”

Management of lymphoedema

“…Nevertheless, it can be debated whether the tools used in advanced assessment are actually advanced or essential in obtaining a diagnosis for the patient. It is often easy to diagnose a patient with a dependency oedema from the clinical questioning and physical examination, but it is much more diffi cult to draw a conclusion of diagnosis when the patient has a type of primary lymphoedema or questioning leads to other causes [22].…”

“…This reduces the requirement for regular dressing changes; however, it does not replace the necessity of daily washing and moisturising of the skin. This situation is particularly important where there are high levels of dryness, skin sensitivity or hyperkeratosis [22].…”