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

One
Two
Three
Commonly referred to as the mild, pitting or reversible stage. Accumulation of protein-rich fluid is present
in the tissues, the affected region or limb appears mildly swollen and pitting is evident (i.e. when you press
into the skin a temporary dent/pit is seen and persists – termed pitting edema). Elevation of an affected limb
tends to resolve or reduce the swelling; however, fluid accumulation will reoccur in time once the limb is
lowered. Although this stage can include an increase in proliferating cells (e.g. fibroblasts, which in turn
can stimulate collagen production), this stage is considered reversible because skin and tissues have not
been permanently damaged. Proper management at this stage can assist the restoration of normal extremity
circumference and lymphatic function, thereby preventing or reducing the risk of further progression
toward irreversible changes (Zuther 2011). Once you have acquired mild lymphedema, you are at higher
risk for moderate-to-severe lymphedema than someone who has never had any symptoms and this risk can
persist even if your symptoms resolve with treatment.
Commonly referred to as the moderate or spontaneously-irreversible stage. In this stage regional swelling is
more pronounced, there is no reduction in swelling with elevation and pressing into the skin does not leave
a dent/pit (termed non-pitting edema). Inflammation and subsequent fibrosis accompany this stage.
Hardening, or thickening of the tissue is evident. This stage can be managed with treatment, but any tissue
damage cannot be reversed. A reduction in fluid volume and fibrosis may be achieved through proper
treatment (e.g. manual techniques and compression garments) (Zuther 2011). Lymphedema often stabilizes
in stage II. However, if untreated, protein-rich fluid can continue to accumulate, sometimes resulting in
progression to stage 3.
Commonly referred to as severe or lymphostatic elephantiasis. This – most advanced – stage is relatively
rare in people with breast cancer. With stage 3, the affected limb or area of the body presents as large and
misshapen, the skin takes on a leathery, wrinkled appearance and there is evident skin thickening (fibrosis),
hardness and large limb volume (elephantiasis). Pitting is not present in this stage. As noted in Chapter 3,
the increase in protein-rich fluid and fibrosis prevents oxygen and other essential nutrients from reaching
the area and creates an ideal environment for bacteria, which in turns sets the stage for subsequent recurrent
infections (lymphangitis). With this stage, fluid reduction is still possible with proper treatment, but in most
cases the duration of intensive complete decongestive therapy has to be extended and repeated several
times. In extreme cases the surgical removal of excess skin following the conservative therapy may be
indicated.