[libribook.com] Traumatic Scar Tissue Management 1st Edition
LymphedemaLymphedema is an abnormal accumulation of protein-rich lymph in theinterstitial spaces (Zuther 2011). Lymphedema – considered to be a disease – canpresent as acute or chronic and if left untreated can evolve into a permanent,disfiguring condition. Most common areas for lymphedema are the extremities(arms and legs) but it may also develop in the breast, head, neck, trunk orgenitals.Causes of lymphedema include trauma in the form of infection, cancer, scartissue from radiation therapy or surgical removal of lymph nodes and inheritedconditions in which lymph nodes or vessels are absent or abnormal (Zuther2011, National Lymphedema Network 2014).Lymphedema is classified as primary and secondary:• Primary lymphedema: a rare, hereditary condition results from a deficiency inthe development, structure or the function of the lymphatic system (e.g.Milroy disease, Meige lymphedema) (Poage et al. 2008)• Secondary lymphedema occurs as a result of damage to the lymphatic system(e.g. infection, surgical removal of lymph nodes or the use of radiation duringcancer treatment).Early indications of lymphedema include self-reported sensations of heaviness inthe affected limb, edema, tingling, fatigue or aching. Lymphedema may initiallybe dismissed as edema, discomfort and inflammation after surgery. Axillaryparesthesia and pain in the breast, chest and arm have been reported assymptoms of lymphedema. (Poage et al. 2008). Lymphedema associated withbreast cancer treatment will be covered in greater detail in Chapter 6.When the collection of protein-rich fluid remains in a specific area, it usuallyattracts more fluid and increases the inflammation response. This inflammatoryreaction results in scar tissue called fibrosis in the affected area. The increase inviscous fluid (consolidated edema) and resulting fibrosis prevents oxygen andother essential nutrients reaching the area. This process slows down healing andcreates an environment where bacteria can thrive and cause infections on orunder the skin.
Lymphatic treatment protocols will be covered in detail in Chapter 9.ReferencesAspelund A, Antila S, Proulx ST et al (2015) A dural lymphatic vascular system that drains brain interstitialfluid and macromolecules. The Journal of Experimental Medicine 212(7): 991–999.Bellman S, Oden B (1958) Regeneration of surgically divided lymph vessels. An experimental study on therabbit’s ear. Acta Chirurgica Scandinavica 116: 99–117.Chikly B (2002) Silent waves: theory and practice of lymph drainage therapy: with applications forlymphedema, chronic pain, and inflammation. Scottsdale, AZ: IHH Publishing.Choi I, Lee S, Hong YK (2012) The new era of the lymphatic system: no longer secondary to the bloodvascular system. Cold Spring Harbor Perspectives in Medicine 2(4): a006445.Clark ER, Clark EL (1932) Observations on the new growth of lymphatic vessels as seen in transparentchambers introduced into the rabbit’s ear. American Journal of Anatomy 51: 49–87.Davis MJ, Davis AM, Lane MM et al (2009) Rate-sensitive contractile responses of lymphatic vessels tocircumferential stretch. Journal of Physiology 587: 165–82.Földi E, Földi M, Clodius L (1989) The lymphedema chaos. Annals of Plastic Surgery 22: 505–15.Földi E, Jünger M, Partsch H (2005) The science of lymphoedema bandaging. EWMA Focus Document:Lymphoedema Bandaging in Practice.Hodge LM, King HH, Williams AG, Jr et al (2007) Abdominal lymphatic pump treatment increasesleukocyte count and flux in thoracic duct lymph. Lymphatic Research and Biology 5: 127–33.Hodge LM, Bearden MK, Schander A et al (2010) Abdominal lymphatic pump treatment mobilizesleukocytes from the gastrointestinal associated lymphoid tissue into lymph. Lymphatic Research andBiology 8: 103–10.Hodge LM, Downey HF (2011) Lymphatic pump treatment enhances the lymphatic and immune systems.Experimental Biology and Medicine (Maywood) 236(10): 1109–15.Hodge LM, Bearden MK, Schander A et al (2013) Lymphatic pump treatment mobilizes leukocytes fromthe gut associated lymphoid tissue into lymph. Lymphatic Research and Biology 8(2): 103–110.Huff JB, Schander A, Downey HF, Hodge LM (2010) Lymphatic pump treatment enhances the lymphaticrelease of lymphocytes. Lymphatic Research and Biology 8: 183–7.Langevin HM, Nedergaard M, Howe AK (2013) Cellular control of connective tissue matrix tension.Journal of Cellular Biochemistry 114(8): 1714–9.Louveau A, Smirnov I, Keyes TJ et al (2015) Structural and functional features of central nervous systemlymphatic vessels. Nature; 1 June. Doi: 10.1038/nature14432.Knott EM, Tune JD, Stoll ST, Downey HF (2005) Increased lymphatic flow in the thoracic duct duringmanipulative intervention. The Journal of the American Osteopathic Association 105: 447–56.Kriehuber E, Breiteneder GS, Groeger M et al (2001) Isolation and characterization of dermal lymphaticand blood endothelial cells reveal stable and functionally specialized cell lineages. Journal of ExperimentalMedicine 194: 797–808.Macdonald AJ, Arkill KP, Tabor GR et al (2008) Modeling flow in collecting lymphatic vessels: onedimensionalflow through a series of contractile elements. American Journal of Physiology – Heart andCirculatory Physiology 295: H305–13.
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Lymphedema
Lymphedema is an abnormal accumulation of protein-rich lymph in the
interstitial spaces (Zuther 2011). Lymphedema – considered to be a disease – can
present as acute or chronic and if left untreated can evolve into a permanent,
disfiguring condition. Most common areas for lymphedema are the extremities
(arms and legs) but it may also develop in the breast, head, neck, trunk or
genitals.
Causes of lymphedema include trauma in the form of infection, cancer, scar
tissue from radiation therapy or surgical removal of lymph nodes and inherited
conditions in which lymph nodes or vessels are absent or abnormal (Zuther
2011, National Lymphedema Network 2014).
Lymphedema is classified as primary and secondary:
• Primary lymphedema: a rare, hereditary condition results from a deficiency in
the development, structure or the function of the lymphatic system (e.g.
Milroy disease, Meige lymphedema) (Poage et al. 2008)
• Secondary lymphedema occurs as a result of damage to the lymphatic system
(e.g. infection, surgical removal of lymph nodes or the use of radiation during
cancer treatment).
Early indications of lymphedema include self-reported sensations of heaviness in
the affected limb, edema, tingling, fatigue or aching. Lymphedema may initially
be dismissed as edema, discomfort and inflammation after surgery. Axillary
paresthesia and pain in the breast, chest and arm have been reported as
symptoms of lymphedema. (Poage et al. 2008). Lymphedema associated with
breast cancer treatment will be covered in greater detail in Chapter 6.
When the collection of protein-rich fluid remains in a specific area, it usually
attracts more fluid and increases the inflammation response. This inflammatory
reaction results in scar tissue called fibrosis in the affected area. The increase in
viscous fluid (consolidated edema) and resulting fibrosis prevents oxygen and
other essential nutrients reaching the area. This process slows down healing and
creates an environment where bacteria can thrive and cause infections on or
under the skin.