Lymphoedema Resources

Increasing pressures on healthcare resources require constant evaluation of the efficiency and effectiveness of provision, particularly for the rising number of vulnerable, elderly and obese patients. Practices regarding compression are arguably often ingrained due to its historical usage, with evidence from managing chronic venous insufficiency (CVI) underpinning its effectiveness. This evaluation explores the clinical benefit, impact, outcomes and cost-efficiencies of using an adjustable compression wrap system instead of previous care. ‘Before-after design’ observation of 50 patients captured baseline resource use, costs and outcomes (clinical and patient) at the time of assessment and again at a maximum of six-month follow-up. Data after using the adjustable compression wrap showed significantly improved clinician-reported outcomes: presence of wounds/leg ulceration (from 56% to 21%), incidence of cellulitis (halved), and reduced complexity/severity of lymphoedema. Additionally, patient- reported outcomes, visual analogue scale (VAS) health score and LYMPROM© scores for pain, heaviness, shopping for shoes and clothes, and body image significantly improved. The mean number of community nurse visits per patient reduced from 11.6. to 9.1, but was not statistically significant (p-value 0.09). However, this evaluation found that over six months there was a mean cost reduction of over £383.70 per patient, which included the purchase price of the adjustable compression wrap system.

Lymphoedema is a long-term condition which is incurable at the present time. Due to the nature of the condition, being both long-term and manifesting in physical changes (swelling), its impact on the person and their lives can be hard to quantify. Management options need to be considered within a person-centred approach, with the four cornerstones of treatment being skin care, exercise, compression therapy and manual lymphatic drainage (MLD). Evidence for each is varied and practitioners need to determine their therapeutic benefit. Beyond the cornerstones of treatment, future developments are ongoing within the areas of surgery, such as venous anastomosis and pharmacological interventions, which may reduce the effects of continual inflammation. In the future, these developments may become part of the care delivered to those affected by lymphoedema. However currently, skin care, exercise, and compression therapy remain fundamental, with MLD included if therapeutically indicated, as well as educating and empowering those involved in selfmanagement with the support of practitioners.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

Lymphoedema is a chronic, progressive condition, which can have a significant impact
on patients — both physically and psychologically. While there is no cure, it is vital that the condition is effectively managed to prevent deterioration and its impact on patient quality of life.

According to a best practice statement (Wounds UK, 2019), wound complexity increases the likelihood of wound chronicity and can make a wound hard to heal. A ‘complex’ venous leg ulcer (VLU) has a number of indications that link to lymphovenous disease

This article explores why we should adapt assessment of leg ulceration to be more mindful of the presence of lymphoedema. If clinicians can change the assessment process and begin to treat leg ucleration with a lymphatic component differently to venous oedema, this, in turn, can potentially reduce complications such as toe, foot and knee oedema. The introduction of simple changes in documentation and additional training can lead to improved outcomes for patients as well as potential cost savings for healthcare providers.  

To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.

To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.