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

Clinical Consideration
Early detection and treatment of lymphedema may limit the progression
and risks associated with more pronounced lymphedema. While subclinical
lymphedema can be detected using methods such as perometry and
bioimpedance spectroscopy, these technologies are not widely available.
Alternatively, several studies indicate that patients’ self-reported symptoms
are accurate indicators of early lymphedema. Early intervention (e.g.
manual lymph treatment, compression garments) – during the more easily
manageable stage – has been shown to result in effective outcomes.
As noted in Chapter 3, lymphedema is classified as primary or secondary.
Secondary lymphedema – seen in conjunction with the surgical removal of
lymph nodes or the use of radiation during cancer treatment – rarely happens in
isolation. Scarring (soft tissue fibrosis), deficits in muscle strength, flexibility
and hypersensitivity are usually present. These symptoms are due to damage
sustained to the supporting and organizational aspects of the fascial and CT
structures and their response to the healing process (Fourie 2008).
There are a number of tissue composition changes in secondary lymphedema
due to the stagnation of the lymphatic fluid. The skin of the lymphatic arm can
change from soft and pitting to hard, heavy and fibrotic with time. Use of
tomography and magnetic resonance imaging (MRI) has demonstrated a pattern
of circumferential edema and ‘honey combing’ with infiltration of the fibrosis in
the subcutaneous tissue region. An increase of adipose tissue was also
discovered around the lymphatic limb (Dylke et al. 2013).
Stage
Zero
Description
Commonly referred to as latent, subclinical or pre-lymphedema, this presentation is typically seen in
conjunction with those that have undergone surgical lymph node dissection with subsequent disruption of
lymphatic pathways. Although the transport capacity of the lymph system is reduced resulting in impaired
lymph flow – swelling is typically not evident. Generally there are no visible changes to the affected area;
however, the individual may notice a difference in feeling, such as fatigue, mild regional numbness,
tingling, fullness or heaviness, which may be accompanied by low-grade discomfort. The individual may
notice difficulty or discomfort fitting into clothing, and jewelry may feel tight (e.g. rings, watch bands).
This stage may last for months or many years, with eventual development of more obvious signs of lymph
impairment.