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Skin and Wound Care in Lymphedema Patients: A Taxonomy, Primer, and Literature Review

Fife, Caroline E. MD, FACCWS; Farrow, Wade MD, FACCWS, CWSP; Hebert, Adelaide A. MD, FACCWS; Armer, Nathan C. MEd; Stewart, Bob R. EdD; Cormier, Janice N. MD, MPH, FACS; Armer, Jane M. PhD, RN, FAAN, CLT

Advances in Skin & Wound Care: July 2017 - Volume 30 - Issue 7 - p 305–318
doi: 10.1097/01.ASW.0000520501.23702.82

BACKGROUND: Lymphedema is a condition of localized protein-rich swelling from damaged or malfunctioning lymphatics. Because the immune system is compromised, there is a high risk of infection. Infection in patients with lymphedema may present in a variety of ways.

OBJECTIVE: The goals of this review were to standardize the terminology of skin breakdown in the context of lymphedema, synthesize the available information to create best practice recommendations in support of the American Lymphedema Framework Project update to its Best Practices document, and create recommendations for further research.

DATA SOURCES: Publications on skin care and wounds were retrieved, summarized, and evaluated by a team of investigators and clinical experts.

STUDY SELECTION AND DATA EXTRACTION: Terms for lymphedema-associated skin breakdown were compiled and paired with photographs of commonly noted skin changes among patients with lymphedema. A list of standard dermatological terms was created. A more extensive literature search was then conducted by all authors.

DATA SYNTHESIS: Skin disorders associated with lymphedema have been classified into 5 categories. Descriptions, photographs, and recommendations for treatment are presented.

CONCLUSIONS: Skin care is an important defense against infection. Because of the lack of research, a consensus of thought and content leaders’ opinion should guide the best practices for wound care in lymphedema.

Caroline E. Fife, MD, FACCWS, is Adjunct Professor, Division of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas; Medical Director, CHI St Luke’s–Wound Care Clinic, The Woodlands, Texas; Chief Medical Officer, Intellicure, Inc, The Woodlands, Texas; and Executive Director, US Wound Registry, The Woodlands, Texas. Wade Farrow, MD, FACCWS, CWSP, is US Medical Director and Vice President of Wound Care, BSN Medical, Charlotte, North Carolina; and Board Member, National Lymphedema Network. Adelaide A. Hebert, MD, FACCWS, is Professor, Departments of Dermatology and Pediatrics, UTHealth McGovern Medical School, Houston, Texas. Nathan C. Armer, MEd, is Research Specialist, Sinclair School of Nursing, University of Missouri, Columbia, Missouri. Bob R. Stewart, EdD, is Professor Emeritus, College of Education, Sinclair School of Nursing, University of Missouri, Columbia, Missouri. Janice N. Cormier, MD, MPH, FACS, is Professor, Surgical Oncology and Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, Texas. Jane M. Armer, PhD, RN, FAAN, CLT, is Professor, Sinclair School of Nursing, University of Missouri, Columbia, Missouri.

The authors have disclosed that the American Lymphedema Framework Project (ALFP) staff and reference librarian’s time were supported by industry donations to the ALFP. All authors donated their time in preparation of this manuscript. Dr Fife has disclosed that she is Executive Director of the US Wound Registry, a 501c(3) organization, and Chief Medical Officer of Intellicure, Inc. Dr Farrow has disclosed that he is US Medical Director and Vice President of Wound Care, BSN Medical, which manufactures compression garments. Submitted February 12, 2017; accepted April 17, 2017.

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