Everyone of us will from time to time get wounds on our lymphedema limbs. If your a clutz like me, you will get them from accidents.
They also may be caused by insects bites, such as ants or mosquitos.
More often however, there will be times when our skin just pops open and starts draining. When this happens, you must take care of the wound immediately. The fluid that seeps out will very quickly cause surrounding skin tissue to deteriorate and in no time that tiny wound can become a very serious problem.
Untreated wounds also leave a wide open entry foci for bacteria.
The resulting infections dramatically increase the severity of the lymphedema, can result in sepsis, gangrene, amputation or death.
Finally, it is important also to utilize the care of a wound treatment clinic if you continue to have problems with a wound healing or if any signs of complications and/or infections set in.
Wound Care, What is a Wound, Lymphedema Emergency Wound Kit, Treatment of Superficial Wounds on a Lymphodemous Limb, Contraindications in wound healing, Wound complications, Wound Classification, Hyperbaric Wound Treatment, Lymphorrhea, Wound Treatment
A wound is defined as any physical injury involving a break in the skin. For none lymphedema people generally wounds are caused by an act or accidently rather than a disease. These involve cutting yourself with a kitchen knife, stumbles and trips, falling, running into things, puncture wounds etc.
Lymphedema people however, experience wounds that are directly related to their medical condition. These are the weeping spots, the ulcerations, those areas where our skin just pops open. These will need to be treated differently than regular accident wounds.
Below is a supply list of basic first aid supplies I always keep on hand.
List of supplies never to use
Never use regular surgical tape on a lymphodemous leg
Never use regular bandaides because of the tape
Never use plastic tape of any kind
(Because of skin condition involved with lymphedema these would present further problems by damaging the skin)
I learned a wonderful technique from a wound clinic several years ago. This is excellent for superficial wounds.
I use a very simply, but effective ointment. Desitin with zinc, thats right baby diaper ointment.
Cover the wound with ointment and place several pieces of square gauze over it. Wrap the affected part of the limb with rolled gauze and then wrap around that with an elastic bandage. Wrap firm but not over tight, using a criss cross method (figure eight).
NOTE: This is for superficial wounds only. If the wound does not clear up within a few days, consult your doctor. You must also see your doctor immediately if it is a large wound or injury or if there begins to be inflammation or infection.
Sometimes, you may even need to go to a Wound Clinic. I have found them to be wonderful and very helpful.
With the lymphedema patient, wound care is more difficult and presents a greater challange that with a normal lymph flow limb.
Included in these contraindications are:
Lymphorrhea - very caustic and destructive fluid weeping from the wound. The fluid causes further destruction of the skin and is a major impediment to healing.
Localized Immunodificiency - The affected limb is simply not able to fight the infections that may be present. Antibiotic therapy is necessary.
Tissue quality and fibrosis - Fibrotic tissue simply does not heal as normal tissue. Wound treatment may require extended therapy.
Impaired vascular flow - In late stage lymphedema, the blood flow may be impaired, preventing nutrients and needed oxygenation to the wound.
Swelling - Compression bandages are required to prevent further swelling of the limb. Swelling not only “pulls” apart tissue that is attempting to heal, but causes further drainage of lymphorrhea.
This list of wound complications is actually very simple:
If you have any type of wound, immediate care is required.
To understand wounds and how they might be treated, it is necessary to understand the various stages of classifications of wounds.
Simple clean wound in the epidermal layer of the skin. In this stage there is no infection or inflammation. The wound is not invasive or traumatic and no other body systems are either afected or involved.
Lymphedema patients may easily with the correct techniques treat these wounds. However, if any sign of inflammation or infection, I strongly urge intervention by a medical professional.
The wound is still “clean.” Beginnings of inflammation or infection may be evident. It is critical that lymphedema patients consult and be supervised by a medical doctor. At this stage antibiotic therapy should be implemented.
At this stage the wound is contained in the epidermis or very slightly in the endodermis or dermis layer of the skin.
Treatment by primary care physician may be all that is required.
However with lymphedema, long standing wounds, even at this stage may call for treatment at a wound clinic.
This is a serious stage that generally will involve not only the epidermis, endodermis but the subcutaneous tissue as well. Wounds at this stage are generally caused by a serious or traumatic injury. Immediate care is critical to prevent further complications or infections.
At this stage it also may become important for referral to a wound treatment clinic.
Antibiotic treatment or therapy is mandatory.
In this class which involves deep long standing wounds, there is generally involvment of extensive infection and contamination. Wounds may be caused by extensive trauma or injury. Sepsis or septicemia is a real danger. Wound in this class may require extensive debridement and/or skin grafts for proper healing. There may be numerous complications you will experience with lymphedema. On this page I am going to list some of them. On our forums and other pages there will be additional information and links relating to each one in particular.
The process of healing is slow and goes through several stages. The first stage is called the inflammatory, resting or lag phase because it appears that very little is happening. In fact this is a very active phase. It lasts several days.
The second stage, during which time the body is producing collagen to strengthen the wound, is called the metabolic phase and lasts several weeks. At this time, the body produces stronger, thicker scars than are ultimately needed.
The final stage of healing is the remodelling phase. It is during this time that the body refashions the scar and decides how much will remain.
These three stage have significance for the patient During the phase of inflammation the scar is not strong. The wound becomes increasingly red. The redness lasts through the active or metabolic stage. It is easy to confuse with infection because the scar is so red.
The redness does not begin to fade for at least six weeks after the operation or injury. It is at this stage that the scar is strong. In youngsters and those with fair skin the redness is often very prolonged and can last months. Some patients form a persistently heavy scar called a keloid.
Many factors can affect wound healing including diabetes, vitamin deficiencies and smoking.
A wound is not fully healed for one to two years. It is rare to revise or re-do scars until they are completely mature. http://www.phudson.com/OTHER/HEALING/healing.html
Infection can develop after an injury or wound to the skin or mucous membranes (such as the inside of the nose or mouth), a bite or sting, a tattoo or piercing, or other skin problems. Signs of infection may include
Bruises usually do not become infected unless the skin was cut, punctured, or scraped. Most wounds will not become infected if they are properly cleaned and cared for. If you have a cut, puncture, or scrape, see the Home Treatment section of the topics Cuts, Puncture Wounds, or Scrapes, and follow the steps for cleaning and caring for a wound to reduce your risk of infection.
It is important to watch for signs of infection during the healing process. Wound infections are more likely to develop if
Minor wound infections can lead to serious infections, such as
Prompt treatment of a wound infection can prevent serious complications.
All open wounds are contaminated to some extent and are potential sites for infection. The best way to prevent infection is to remove all debris from the wound and discourage further growth of bacteria.
Scrub hands thoroughly with soap and disinfected water.
Put on latex gloves to prevent the spread of infectious disease.
Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter disinfected water. See “How to Disinfect Water.” Set the disinfectant solution aside for about five minutes.
You will need to have at least 1 liter of disinfectant solution on hand for this procedure.
Use a clear plastic bottle with measurements on the side, such as a Nalgene bottle, for easy measurement when mixing the disinfectant solution. These bottles include measurements in milliliters and ounces.
If povidone-iodine solution is not available, use disinfected water to cleanse the wound.
Infectious diseases such as AIDS and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing latex gloves. Wear goggles or glasses to protect against spurting blood or fluids. Wear a surgical mask to prevent the spread of other diseases. If you don't have gloves, a surgical mask and goggles, improvise by placing your hand in a plastic bag, wearing sunglasses, and covering your mouth with a bandanna.
Step One Scrub the area around the wound using a nailbrush and disinfectant solution. Scrubbing may be painful to the injured person, but it is important that all debris is removed.
Step Two Sterilize a pair of tweezers using the disinfectant solution.
Step Three Remove all large pieces of dirt, debris, dead skin and flakes of clotted blood from the wound.
Step Four Draw the disinfectant solution into an irrigation syringe.
Step Five Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will flood the wound and drain away from the opening.
Step Six Press down on the plunger to emit a forceful stream of solution.
Step Seven Repeat the irrigation using 1/2 to 1 liter of solution. You may need to use more if the wound is especially dirty.
Step Eight Rinse the wound liberally with disinfected water, because the disinfectant solution may cause irritation to the skin if left on.
Step Nine Recheck the wound for bleeding; blood clots may have been dislodged. You may have to apply pressure to stop bleeding. See “How to Stop Mild Bleeding During First Aid.”
Step Ten Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, because this may cause burning.
Step Eleven Bandage the wound immediately after it has been thoroughly cleansed of all debris. See “How to Bandage a Wound During First Aid.”
Irrigation syringes are also called pressure irrigators. If an irrigation syringe is not available, improvise by puncturing a plastic bag with a small hole, drilling or burning a hole into the top of a water bottle, or using a sports bottle with a squirting top. The idea here is to create a high-pressure flow of water, which will remove debris without damaging the tissue.
Do not use alcohol, iodine or mercurial solutions to cleanse a wound; these can damage the tissue. eHow
The cut bleeds in spurts, blood soaks through the bandage or the bleeding doesn't stop after 10 minutes of firm, direct pressure
Smoking and Wound Healing
Wound Care Discussion Forums