[libribook.com] Traumatic Scar Tissue Management 1st Edition

Table 6.3
Baker scale
Cancer treatment is the leading cause of lymphedema in developed countries.
Development and severity of lymphedema have a significant impact on comfort,
psychological distress and overall quality of life. Development of lymphedema
and at what point in a patient’s recovery stage it may manifest are wide ranging.
Some research studies indicate factors such as variations in anatomy, surgical
procedures and radiotherapy may play a part in lymphedema development
(Fourie 2008).
Quantitative lymphoscintigraphy – a method used to check the lymph system for
disease (e.g. lymphoma, lymphedema) – reveals that lymph drainage is slowed
in the subcutis (deeper part of the dermis), where most of the edema lies, and in
the subfascial muscle compartment, which normally has much higher lymph
flows than the subcutis.
Although the associated musculature does not swell significantly, the impaired
drainage correlates with the severity of arm subfascial swelling, indicating an
important role for muscle lymphatic function (Stanton et al. 2009). The farreaching
consequences of chronic lymph stasis is not completely understood;
however, what is known is that the accumulation of the protein-rich interstitial
fluid lends to early and progressive predisposition to tissue fibrosis. Components
of the epidermal and dermal layers thicken significantly which, in turn, increases
the thickness of the subcutaneous adipose layer (Rockson 2013).
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 is generally defined by the consistency of the tissues, not the