Prevalence and characteristics of lymphoedema at a wound-care clinic
Lymphoedema is estimated to affect up to 300,000 Canadians but remains under-recognised and undertreated. A retrospective chart review was conducted to determine the clinical characteristics and treatment practices of lymphoedema in a Canadian wound care clinic.
Data were collected retrospectively from dictated clinic notes of 326 lymphoedema patients at a wound clinic in a regional rehabilitation hospital.
The mean age (±SD) of diagnosis was 66.8 (±15.5). Patients had 7.3 (±3.3) comorbidities and took 8.4 (±4.6) concomitant medications. The most common comorbidities were venous disease (73%), hypertension (60%), and obesity (46%). Clinic patients were less likely to be women, have arm lymphoedema, or have cancer-related aetiology compared with previous studies, reflecting a two-tiered model of care delivery in the area. Treatments prescribed by the clinic were consistent best practice recommendations for conservative treatment.
A significant proportion of the wound clinic's patients had lymphoedema. Lack of resources, lack of awareness among primary care providers, and patient adherence are barriers to lymphoedema care.
Lymphoedema is a chronic, debilitating condition arising from the accumulation of protein-rich fluid buildup in the skin. Primary lymphoedema is caused by malformed or absent lymphatics.1 Secondary lymphoedema has a variety of causes, including infection, chronic venous insufficiency, obesity, trauma, surgery, and immobility.1,2 Multiple factors may contribute to the underlying lymphatic dysfunction that leads to the development of lymphoedema. The most common cause of secondary lymphoedema worldwide is lymphatic filariasis affecting over 150 million people worldwide primarily in sub-Saharan Africa and Southern Asia. In developed countries, the most common aetiology is thought to be cancer treatment and/or its treatment.3
Regardless of aetiology, lymphoedema causes significant physical and psychosocial morbidity. Untreated lymphoedema can lead to recurrent infections, hospital admissions, and deformity of the affected limb.4 Reduced quality of life and employment difficulties have also been reported.5 The chronicity of the condition, for which there is no cure, may also be a source of frustration for patients. Management may include meticulous skin care, exercise, manual lymphatic drainage (MLD), a specialised form of massage, and compression therapy. Of these, the key treatment is compression therapy, which must be kept up indefinitely to be effective.6,7
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