Complete Decongestive Therapy - The National Lymphedema ...

andaging of the operative limb (from thetoes to the groin) were permitted earlypost-op, its effect in limiting knee flexionmust be considered. If the patient’s footand ankle swell markedly, safe footwearhas to be provided that:a. fits the patient’s foot adequately toprovide support andb. protectis the foot/toes to reduce therisk for injury to the skin and for falls.An adjustable inelastic compressionlegging may be needed in the firstmonths post-op to allow easy inspectionof the surgical wound and to provideadequate compression to thelimb.• A patient presents to an out-patientphysical therapist (PT) practice 6 weeksafter right mastectomy and DIEP flap reconstructionof the right breast with painfulrestriction of right shoulder flexion andabduction due to pain and tightness in theright axilla extending down the side of thebody including the right upper arm to theelbow. Possible interventions might bemoist heat or other modalities to the rightshoulder/upper arm/lateral trunk, soft tissue(myofascial) techniques to soften tight/adherent tissues, exercise to improve flexibilityand strength. Reduction of pain,maintaining integrity of skin, reducing riskfor infection and risk for LE of the rightupper quarter while improving functionalmovement and strength of the at risk limbmust all be weighed when program planning.The SR supports patient education inrisk reduction and monitoring limb volumesto assess for LE development. A majorweakness in many of the studies cited bythe authors was inconsistent documentationof bilateral baseline limb volumes andfollow-up measurements to monitor limbvolume changes.Patients with or at risk for lower extremityLE should be reminded not to walk barefootat anytime, to reduce the risk of injury/infection of the feet/toes. People with lowerextremity LE are often unaware that theyhave cracks in the skin between their toesfrom fungal infection. This is often the causeof a seemingly “unexplained” cellulitis infection.The healthcare practitioner shouldreview the importance of skin inspection,foot and toe hygiene, and suggest referralto a podiatrist for foot and nail care, as wellas to stress the importance of taking the fulldose and course of antibiotics prescribedfor cellulitis, both oral and topical (if prescribed)to avoid recurrence of infection.Occasionally, lymph fluid may leak from theskin (lymphorrhea) or from blisters/pimpleson the skin that erupt during an episode ofinfection. Adhesive, even from paper tape,can further damage delicate skin, so careshould be taken to secure any gauze ordressings on the affected area. Gauzeshould be taped to itself, not to the patient’sskin.CONCLUSIONThe evidence from the SystematicReview concluded that CDT is effective andhas a positive impact on the quality of life inpatients with varying severities of LE.Healthcare practitioners must be educatedin the anatomy and physiology of the lymphaticsystem and the implication ofreduced lymph transport capacity on anindividual’s risk for developing LE. Incorporatingthis information with a patient’s functionand critical care needs, assist the practitionerin planning interventions needed toTherapy for every body.We have the tools you need for effectivelymphedema treatment at home.Continued on page 25Learn more about Lympha Press ® Systems.CALL 1-888-596-7421 OR VISIT WWW.LYMPHA-PRESS.COMJuly / September 2013 ~ NATIONAL LYMPHEDEMA NETWORK 7