Incorporating attention to detail on lymphatic support to optimise speed of recovery

The lymphatic vasculature has not fundamentally changed; however, our ‘awakening’ to the critical nature of lymphatic function to human health is evidenced by the significant rise in research and clinical publications. The now classic 2014 publication by Drs. Mortimer and Rockson, New developments in clinical aspects of lymphatic disease,¹ is one such manuscript that shifted many of our paradigms in understanding its fundamental importance in relation to cardiovascular disease, cancer, obesity, infection and immune function. For many of us, this paper was our first encounter with the endothelial glycocalyx–the ‘sugar husk’ endoluminal layer which brought transition to the dogmatic Starling Forces. The ‘classical’ is now neoclassical and revised, incorporating the glycocalyx as an active, dynamic, homeostasis-maintaining element to our lexicons. The glycocalyx, as with the lymphatic vasculature, is also on a meteoric rise in research and clinical papers.

Improving lymphatic function as a frontline treatment course in order to accelerate wound healing and decrease recidivism rates is now an educational imperative based on published data. The dermal lymphatics and lymphangion functions are recognised to be fundamentally important to venous leg ulcer (VLU) healing (phlebolymphoedema),² diabetic foot ulcer (DFU) healing (DFUs are recognised to have a component of lymphoedema as hyperglycaemia increases hyaluronic acid losses from the glycocalyx³), and reduction in oedema to improve diabetic wound healing.⁴