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Chronic Oedema
Chronic oedema (also referred to as edema) is defined as abnormal swelling in the tissue which lasts longer than three months and does not completely reduce overnight or with elevation. Swelling in ankles, feet, legs, arms, hands but also the trunk and neck can have many causes but if left untreated can cause further complications, pain and discomfort to the patient.
The four components of Complex Decongestive Therapy
Complex Decongestive Therapy, a combination of treatment approaches for managing lymphoedema is also referred to as Complete Decongestive Therapy or the acronym CDT.
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Skin Care
As the largest organ in the human body, skin is vulnerable to a multitude of threats. Moisturising the skin daily reduces the risk of complications associated with skin breakdown.
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Manual Lympathic Drainage
A gentle, non-invasive manual massaging technique which encourages the natural drainage of the lymph. This lymphatic drainage is part of the lymphoedema treatment to reduce swelling. It is performed by a trained specialist but a simpler version of the massage can be done by the patient at home.
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Compression Therapy
Compression bandaging is a corner stone of Complete Decongestive Therapy for lymphoedema. It is essential to reduce volume to enable the patient to move into compression hosiery.
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Exercise
Exercise is vital for overall and lymphatic health as well as mental well being.
Complications associated with chronic oedema
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Chronic oedema is a progressive condition. The oedema begins as soft and pitting and tends to reduce on elevation
- If the condition is not treated, it becomes non pitting
- Elevation does not relieve the symptoms
- The tissues become harder over time and fibrotic
Pitting vs non pitting oedema
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The difference in pitting and non pitting oedema is demonstrated by applying pressure to the swollen area by pressing down on the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the oedema is referred to as pitting oedema. In non-pitting oedema, pressure that is applied to the skin does not result in a persistent indentation. This kind of oedema is more commen in arms and legs.
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What is the ideal compression
- Incorporate inelastic and elastic components
- Comfortable, i.e. produces a good, anatomical fit
- Allows full functionality and movement
- Comfortable at rest
- Easy to apply and adapt to a range of limb sizes and shapes
- Non-allergenic and durable
Complications associated with oedema
If left untreated, non-pitting oedema can cause a range of complications. As the skin stretches in response to swelling, it can become dry and cracked, leaving it vulnerable to infection. Over time, the swelling can also permanently scar the deep tissue beneath the affected area making it hard and fibrotic. Furthermore it can lead to poor circulation and increase the risk of ulceration.
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Jeroen's story
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Examples of complications associated with untreated oedema
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Cellulitis
Acute inflammation of the skin and subcutaneous tissues.
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Intertrigo/maceration
Wet, soggy skin and tissues.
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Venous leg ulcers
Leg ulcers arising from venous problems are called venous (varicose or stasis) ulcers. They usually develop on the inside of the leg, just above the ankle.
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Fissures
Elongated cleft, break or tear of the tissue.
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Folliculitis
Pustules around the hair shaft.
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Cutaneous fungal infections
Noninvasive infections of the skin, hair, or nails.
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Fibrosis
Excessive hardened tissue.
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Atrophie blanche
Lesions are fragile, smooth, ivory-white plaques associated with changes in the thin soft tissue.
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Lymphorrhea
Leaking, weeping of protein rich lymph.
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Papillomatosis
Warty papilloma develop usually on the foot, giving the skin a ‘cobblestone’ appearance.
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Pressure sores
Damage to the skin or underlying tissure related to pressure on bony prominences.