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Background: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination., Aims: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management., Methods: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B)., Findings: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management., Conclusion: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment.

Background: Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The aim of this study was to explore the impact and outcomes of the OGEP intervention., Methods: Data were captured before and after OGEP on 561 lymphoedema patients in the community setting. Data recorded included resource use, costs and outcomes (EQ-5D-5L and LYMPROM)., Results: Data demonstrated statistically significant reductions in resource allocations including staff visits ( P <0.001), cellulitis admissions ( P <0.001), compression consumables and wound dressing costs ( P <0.001). Overall, the total mean per patient cost decreased from £1457.10 to £964.40 (including intervention) with outcomes significantly improved in EQ-5D-5L/LYMPROM scores., Conclusion: The analysis suggests the OGEP intervention may offer reductions in resource costs and improvements in patient outcomes. OGEP may therefore provide an innovative solution in future care delivery.

Objective: To evaluate the clinical performance, quality of life (QoL) and patient satisfaction with an innovative flat-knit compression garment for the daytime treatment of lymphoedema patients in daily routine., Method: In a prospective multicentre observational study, patients with leg or arm lymphoedema (stage I-II, International Society of Lymphology (ISL) standards, 2016) received a made-to-measure flat-knit compression class 2 JOBST Confidence (BSN-JOBST GmbH, Germany) thigh-high stocking or arm sleeve. Primary endpoint was the oedema status as determined by the mean sum of the circumferences at the beginning and the end of the wearing period. Secondary endpoints included QoL-related parameters and patient satisfaction with product features assessed through questionnaires. The observation period lasted three weeks., Results: A total of 97 patients (87 females, 10 males), of which 65 had leg lymphoedema and 32 had arm lymphoedema, received the study device. The oedema status was effectively maintained (slight reduction in mean sum of circumferences by -3.1±7.3cm; p=0.0001). For QoL-related parameters, the patients reported fewer limitations in work, leisure and psychological wellbeing after wearing the stocking or arm sleeve (all p-values <0.0001). They also experienced less limitations in function and movement, feeling of tension and heaviness, and fewer difficulties wearing clothes, shoes, jewellery or watches at study end (all p-values <0.0001). In terms of pleasant feeling on the skin, moisture management, softness of material, range of motion, overall wearing comfort and heat build-up under the garment, patients were more satisfied with the tested compression garment than with previously worn compression garments (all p-values <0.001)., Conclusion: In this study, the tested innovative compression product increased patient satisfaction with the improved product features while the lymphoedema status was successfully maintained.

Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease.

Genital lymphoedema is a rare but debilitating and disfiguring complication of longstanding hidradenitis suppurativa (HS). Despite the existence of medical and surgical methods that offer varying success rates in a limited number of cases, no data exist about the use of complex decongestive therapy (CDT) in HS-related genital lymphoedema. This case report describes the treatment and outcome of a 56-year-old male patient with severe scrotal lymphoedema due to underlying HS (Hurley stage 3). The patient was unresponsive to various topical and systemic antibiotics and biological agents, including adalimumab and certolizumab pegol. When the patient was assessed, ixekizumab treatment for his HS was planned. He had progressive oedema in the genital area for two years with difficulty in wearing trousers and having sexual intercourse, and painful urination. CDT was recommended for three days a week concurrently with ixekizumab treatment. The patient and his wife were also educated about self-drainage techniques and skincare maintenance. After six sessions of CDT over 14 days, the patient demonstrated a significant reduction in scrotal measurements. He achieved a better scrotal contour, the degree of the buried penis was decreased, and urination was easier and painless. The findings of this case report showed that CDT was an easily applicable, practical and promising method that offered a rapid treatment response for HS-related genital lymphoedema.

The case study described in this article shows the use of different approaches and techniques that need to be utilised when treating patients presenting with a combination of venous and lymphatic disease (lymphovenous) in order to improve complex wound outcomes. The author highlights how lymphoedema can affect the wound healing process by increasing the risk of recurrent infection and a hardening of the tissues (fibrosis), reducing oxygenation and lymphatic flow to the wound, leading to chronic complex wounds.

Joanne Dodd-Stokes , and the LymphCare UK Team, LymphCare UK (jdodd-stokes@lymphcare.co.uk) winners of a Silver Award in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

Rachel Mayall , Lead Lymphoedema Practitioner, Rochdale Care Organisation, Northern Care Alliance (Rachel.Mayall@nca.nhs.uk), winner of a Bronze Award in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

Objective: The aim of this case report is to describe the results of complex decongestive therapy (CDT) in a patient with poliomyelitis and bilateral lymphoedema, and to emphasise the effect of CDT on wound healing., Method: A 48-year-old female patient was given CDT for bilateral grade 3 lymphoedema in the lower extremities and a deep wound on the right foot. She had been diagnosed with poliomyelitis sequela and mobilised with a wheelchair for 26 years. The lymphoedema on both legs and the wound on the right foot sole had been present for five years and eight months, respectively. Detailed wound care had been performed previously upon the green, malodorous infected wound, without healing. The patient received skin care education, manual lymphatic drainage, multilayer bandaging and exercises for 4 weeks in a total of 20 sessions. The improvement was assessed by limb volumes prior to and at the end of the treatments., Results: The right and left lower limb volumes were decreased significantly at the end of treatments (3042cm³ (R) and 3165cm³ (L) before versus 2702cm 3 (R) and 2401cm 3 (L) afterward). The wound size decreased considerably and the green malodorous flow ceased. The patient continued self-massage and self-bandaging after hospital discharge. The control follow-up, one month later, revealed a completely healed wound with maintained volume., Conclusion: In conclusion CDT for a duration of 4 weeks in a female patient with poliomyelitis, bilateral lymphoedema and an infectious hard-to-heal wound, improved both the lymphoedema and wound healing.

Introduction: Compression therapy is important in oedema control in lymphoedema. However, some patients have difficulties starting compression therapy because standard self-care education does not enable them to fully understand lymphoedema and recognise it as their problem. To overcome this, real-time image-sharing education, using a combination of indocyanine green lymphography (ICG) and ultrasonography, may be used to educate patients. In this case study, real-time image-sharing education promoted decision-making and behaviour change in a patient with lower extremity lymphoedema so she would wear elastic stockings., Case: A 51-year-old woman with a BMI of 31.7 kg/m 2 and secondary lower extremity lymphoedema following cervical cancer surgery did not adhere to self-care instructions regarding wearing elastic stockings for 5 years. The oedema worsened, her limb circumference increased and she had two episodes of cellulitis within a year. Because the patient had a negative attitude towards elastic stockings, real-time image-sharing education was used to promote recognition of illness using ICG and an understanding of the condition of lymphoedema using ultrasonography. After the images were shared and explained, the patient discussed her recognition and understanding of lymphoedema, then decided to use compression stockings. She continued to wear them for 4 months, and her limb circumference decreased., Conclusion: Real-time image-sharing education using ICG and ultrasonography as self-care support for a lymphoedema patient who would not start compression therapy could result in behavioural changes and the patient starting and continuing to wear elastic stockings.

Aim: Lymphoedema is associated with dysfunctional lymphatics, tissue fibrosis and inflammatory changes in the skin and local tissue. Ensuring compression supports tissue health is crucial to managing lymphoedema. Providing patients with safe compression which enhances their tissue health is paramount when supporting their 24-hour self-management regimens. This case study explores the use of a new compression garment in two sitting positions in an adult with primary lymphoedema., Method: An 18-year-old female (body mass index 25.2 kg/m 2 ) with Milroy's disease was recruited. She attended two separate 1-hour sessions to evaluate tissue oxygenation (StO 2 ) in chair-sitting and long-sitting (sitting up with a supported back and legs horizontal) positions. Following removal of her usual class 2 (20-30 mmHg) flat-knit compression hosiery, StO 2 was recorded for 20 minutes: pre-, during and post the application of an adjustable compression garment (Lohmann & Rauscher) to the right leg., Results: In the long-sitting position, StO 2 levels started high at baseline (94.5%), and were relatively maintained both during and post-a short 20-minute intervention (94.1%). In the chair-sitting position, StO 2 levels were significantly lower at baseline (52%), showing a 77% increase during the intervention (92%), followed by a small 9% decrease post-intervention (83.7%)., Conclusion: This compression garment significantly increased StO 2 levels in the chair-sitting position, while maintaining the effects of the patient's compression stockings, in the long-sitting position. Similar to non-lymphoedematous limbs, the patient's normal prescription hosiery maintains StO 2 . Through implementation of the short intervention sessions, night compression garments may have the potential to improve tissue health in individuals with primary lymphoedema, encouraging self-management and offering a potential night compression solution where the need arises in a 24-hour management plan.

Objective: The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan., Method: Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm 3 ) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm). Subjective comments on functional abilities and perception of improvement with a compression plan that comprised a 24-hour interval were documented., Results: All three patients presented in this case series had a reduction in limb volume and improvement in QOL when their daytime regimen of garments was updated and new night-time garments were added. Their subjective comments indicated improvement in activities of daily living and ease of controlling daytime oedema with a 24-hour interval compression plan., Conclusion: This case series illustrates the need for clinicians to create a partnership with the patient to promote concordance and adherence as part of their individual 24-hour interval compression plan. This partnership allows the plan to be uniquely changed and adjusted to allow each patient to feel in control of refreshing their mood, their skin and their garments.

Weight management and psychological health are intertwined. Patients in this context are often mindful of how to eat healthily and what they need to do to lose weight, but frequently self-sabotage, with external influences often impact any attempted weight-loss approach. Consequently, any form of lymphoedema management is also thwarted and vicious cycles between success and rebound occur. This article describes a 6-week weight-management programme that took place before the COVID-19 pandemic. The programme focused exclusively on the expectation that, if a patient's psychological health could be improved, weight reduction would occur as a result, and, in turn, any positive effects on adherence with lymphoedema treatments could be observed.

Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval. The benefits of this focus on interval compression therapy on all aspects of care will be explained and case studies presented.

Kathryn Taylor , Lymphoedema Clinical Nurse Specialist and Service Lead, Community Lymphoedema Service, Manchester Local Care Organisation (kathryn.taylor3@mft.nhs.uk), was runner-up in the Chronic Oedema Nurse of the Year category in the BJN Awards 2021.

To ensure lymphoedema patients in Wales receive the right care, at the right time, by the right person, patient-reported outcome measures (PROMs) were routinely completed within the All-Wales lymphoedema assessment documentation. This evaluation describes the development of the Lymphoedema Patient Reported Outcome Measure (LYMPROM), which is a tool developed by Lymphoedema Network Wales clinicians and key stakeholders. The tool was explored for face, form and content validity during 3 months in 2019; 128 anonymised completions of LYMPROM were reviewed to establish feasibility, acceptability and internal validity using Cronbach's alpha. LYMPROM was feasible and acceptability was high. Face and content validity were reported (i-CVI [item content validity index] range=0.43 - 1; s-CVI/Ave=0.94) and internal consistency was excellent (0.958). LYMPROM was easily integrated within lymphoedema services in Wales, promoting patient-led care and supporting value-based health care. Further evaluations of reliability and validity of LYMPROM are proceeding along with digital integration.

Objective: Lymphoedema is a debilitating condition that results in the swelling of one or more limbs, leading to a significant impairment of mobility. From a psychosocial perspective, body image and quality of life (QoL) are also adversely affected. To date, non-cancer lymphoedema has been under-researched. The primary objectives of this study were to explore QoL and limb volume in patients with primary and secondary non-cancer-related lower limb lymphoedema during the intensive, maintenance and self-care phases of complex decongestive therapy over a 24-week period. Secondary objectives included exploring patients' experiences of living with lymphoedema and the challenges of self-care maintenance., Method: A sequential mixed methodology, using quantitative and qualitative methods, was used. The quantitative part of the study involved the use of tape measurements at 4cm intervals to ascertain limb volume alterations. Measurements were taken during the intensive phase at weeks 1, 2, 3 and 4; and during the maintenance phase at weeks 8, 16 and 24. QoL was measured using the lymphoedema QoL (LYMQOL) leg, at baseline and weeks 8 and 24. The qualitative part of the study involved the use of semi-structured interviews with patients at week 8. Interviews explored the experiences of patients living with lymphoedema and their experiences of complex decongestive therapy., Results: A total of 20 patients were recruited, two male and 18 female, with a mean age of 58.8 years (standard deviation (SD): 16 years), and all receiving complex decongestive therapy. At baseline, for all patients, the mean QoL score was 4.3 (SD: 2.4); and 8 (SD: 1.5) after 8 weeks of complex decongestive therapy. Mean difference was 4.00 (95% confidence interval: 2.76-5.24; p=0.00001) indicating a positive treatment effect. Limb volume measurements demonstrated a reduction in oedema from baseline to week 8. However, there were fluctuations in limb volume over the maintenance period of four months after treatment as the patients endeavoured to engage in self-care. Analysis of the interviews identified themes pertaining to lack of knowledge of lymphoedema among health professionals, a negative impact of living with lymphoedema and the positive therapeutic effect of complex decongestive therapy., Conclusion: Lower limb lymphoedema is a chronic condition that impacts negatively on the individual. Complex decongestive therapy improves QoL and reduces oedema. However, given the fluctuations in oedema post-treatment, individuals need greater support to maintain active engagement in effective self-care strategies.

Lymphoedema is the accumulation of protein-rich interstitial fluid within subcutaneous tissue and skin as a result of dysfunction of the lymphatic system. It is an underestimated, widely neglected and debilitating chronic condition. This article presents an overview of lymphoedema and recent advances in its management.

Objective: Primary lymphoedema is rare and in most cases develops in the lower extremities. In some cases, conservative treatment is insufficient and can be supported by surgical procedure. The aim of this case study was to show the difference in the effectiveness of a compression wrap device and compression stockings in the treatment of primary lymphoedema., Method: Before and after liposuction the patient was treated on an outpatient basis every day for three weeks. This consisted of complex decongestive therapy (CDT) including manual lymph drainage, tailored exercises, skin and nail care, compression therapy and intermittent pneumatic compression. After CDT, the patient was provided with a flat-knit compression garment. Measurements were taken at one week and at three months of wearing the compression garment. The oedema severity was measured by summary calculation method. For both healthy and swollen limbs, the sum of circumferences taken at nine fixed measuring points was determined. The difference between these sums expressed in percents was presented as a relative metric coefficient of leg lymphoedema (RMCL)., Results: At the start of therapy, the difference in circumference between the healthy and swollen limb was 21.85%. After CDT (RMCL: 13.46%), the patient was provided with a flat-knit compression stocking (class 3). After one week, the RMCL was 15.92%, while after three months RCML was 20.84%. Because fluid retention was observed the patient was again treated with CDT (RMCL: 13.89%). The patient was provided with compression stocking (class 4). After one week of wearing, the RMCL was 15.77%, while after three months RMCL was 20.26%. As the results proved unsatisfactory, the patient was treated with CDT (RMCL: 13.60%) and a combination of two class 4 compression stockings was used. After one week, RMCL was 14.91%, while after three months RMCL was 19.25%. As the effects of oedema reduction were insufficient, the patient was treated again with CDT (RMCL: 13.89%) and advised to replace one of the stockings with a CirAid device (adjustable compression wrap). After one week, RMCL was 14.18% and after three months RMCL was 14.76%. The patient then qualified for liposuction (RMCL: 7.81%). At three months after surgery, the compression stocking was replaced by an adjustable compression wrap, to reduce the difference in circumference between healthy and swollen limbs (from 21.85 % to 8.68%)., Conclusion: This case study shows that in primary oedema one class of compression garment is not always sufficient, nor is the combination of two garments with varying degrees of compression. In some cases, the situation requires the use of non-elastic leg binders such as a CircAid device which, thanks to its greater stiffness, helps improve clinical outcomes.

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients-compression stockings and adjustable wraps. The acronym 'S.T.R.I.D.E.', incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence. The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading! Hugo Partsch Emeritus Professor Medical University of Vienna, Austria.

The wearing of compression garments is an essential aspect of the management of lymphoedema. Patients however, do not always receive the requested garment on an NHS prescription from their general practitioner (GP). Through an audit cycle over 3 years, necessary changes in clinical practice were identified and introduced. The aim was to improve the number of patients obtaining the correct garment on an NHS prescription. The audit standard was not met in any of the audits and the conclusion made is that compression garments are difficult to find on NHS electronic prescribing systems leading to a delay in patients receiving their prescription and a risk of error due to the wide range of options available. Further work is necessary to ensure that electronic prescribing systems address the problem of product recognition for compression garments so that the process of obtaining compression garments is smooth, accurate and timely for patients and their GPs.

When Joanne Illsley's son, Archie, was diagnosed with primary lymphoedema she didn't know what it was. In this article, she talks about the journey from diagnosis to today, and what lies ahead for Archie and his family.

Compression, in the form of either a compression bandage or a compression stocking, has been touted as the gold standard for treatment of swelling and venous leg ulcers (VLUs). Adjustable Velcro wraps have been marketed as compression alternative. Although there is a growing body of evidence to support use of these products, there has not been a critical evaluation of the functionality of the devices to best matching product to patient presentation and ability to use the device effectively. Unlike compression garments, which are classified by compression category (class I/II or flat knit/circular), there is not an algorithm to direct health professionals to best match a specific adjustable Velcro wrap to an individual patient presentation. This small case series demonstrates that although each product performed as marketed in vitro, performance in clinical setting varied greatly dependent on patient presentation and functional skill level.

Advances in breast cancer management, including breast-conserving surgery, have resulted in an increase in the incidence of breast oedema. However, this is addressed by professionals less often than arm lymphoedema. Breast oedema results in significant physical and psychological morbidity, makes finding a comfortably fitting bra very difficult, and can act as a reminder of the initial breast cancer diagnosis. Psychological difficulties can be compounded by clinicians' failure to acknowledge the impact. Assessing and managing breast oedema requires a sensitive, skilled approach to ensure all the relevant issues are identified and addressed in a comprehensive care plan; taking time to listen to patients and acknowledging the impact can be very therapeutic. The principles of managing breast oedema are based on lymphoedema practice, particularly manual lymphatic drainage and kinesio taping. This article gives an overview of the identification, assessment and management of breast oedema following treatment of cancer.

Lymphoedema Network Wales was developed in 2011, after receiving a £1 million recurring investment from the Welsh Government to implement its Lymphoedema Strategy. This article describes the creation of the network and the importance of capturing performance data. It will also provide information on the three programmes of work, covering service development, education and research, and innovations and technology. Within Wales, the focus of lymphoedema service delivery is on 'prudent health care', working with patients for patients and only doing what is necessary to gain a good result. Centring our service on evidence-based practice is vital to ensure achievable patient outcomes. The network has grown considerably over the past 6 years and is recognised as a forward-thinking and proactive service.

Rebecca Elwell, Macmillan Lymphoedema Advanced Nurse Practitioner, Royal Stoke University Hospital, discusses recommendations on management of this skin problem, which may co-occur with chronic oedema.

Background: Little is known about the treatment of oedema in palliative care patients., Aim: To outline the assessment, goals, and interventions for patients with oedema., Method: A 6-month chart review of a specialist physiotherapy-led oedema service was carried out., Results: Of the sample group (n=63), 28.6% of patients had lymphoedema, 15.9% had non-lymphatic oedema, 46% had mixed oedema and 9.8% had lymphorrhoea; 58 patients (92%) had cancer. The most common interventions were providing education (100%, n=63), using compression garments (58%, n=37), bandaging (51%, n=32), exercise (38%, n=24), lymphatic massage and kinesio-taping (35%, n=22 each). Treatment regime differed depending on the type of oedema present. Treatment goals were pragmatic: the most common were to maintain skin quality (54%, n=34), reduce limb volume (52%, n=32), and improve quality of life (48%, n=30)., Conclusion: Palliative care oedema can be treated using manual methods, including compression and massage. Goals differ from other oedema populations. Research is hampered by lack of suitable measures to record skin changes and quality of life.

Referral to specialist centres for treatment of lymphoedema can often have long waiting times. Management of a patient with massive lymphoedema and lymphorrhoea was provided in a vascular outpatient setting. A new form of compression using a wraparound system was used for the management (Juxta-Fit, Medi UK). Despite having previously been non-concordant with treatment options, the patient was independent with product use. Lymphorrhoea ceased and there was a marked decrease in girth size. The patient's quality of life improved and maintenance treatment was provided. The use of this compression system could be a valuable treatment alternative to compression bandaging for a select patient group for the treatment of lymphoedema.

Objective: The aim of this small pilot audit was to record the performance of an adjustable Velcro compression wrap, ReadyWrap, and the experiences of patients and health-care professionals using the system as a self-care option for the management of venous and lymphatic leg conditions in both the treatment and maintenance phases., Method: This audit was held within a 4-week review period. Participants included venous leg ulcer (VLU) patients with and without oedema, and patients with lymphoedema. Where open wounds were present they were managed with debridement, skin care and dressings according to clinical need. Lymphoedema patients received manual lymphatic drainage and skin care regimens as per standard practice. The Velcro system evaluated formed part of a treatment pathway with compression bandages and/or compression hosiery as clinically indicated. Patients, carers and health-care professionals applied the garments following assessment and training. Objective data recorded included change in circumferential measurements and improvement in wound status. Observation of health-care professionals, patients and carers with regard to the comfort and ease of application/removal of the device were recorded., Results: There were 17 patients included in the audit. Within the 4-week period a reduction in limb circumference was recorded in all cases. Improvements in open wounds were recorded in most cases. Following the 4-week audit period 94% of the application of the device was performed by either the patient (59%) or the carer (35%) thereby reducing the health-care professional contact that was required for application., Conclusion: Early results in this small audit demonstrate that this adjustable Velcro compression wrap may provide a simple, clinically effective and patient-acceptable solution for self-care with compression. Use of this type of device could have the potential to reduce overall health-care burden by reducing necessary skilled treatment visits and/or cost while still achieving good clinical outcomes. Further studies are required to confirm this pilot study and provide additional data.

Objective: Lymphoedema is estimated to affect up to 300,000 Canadians but remains underrecognised and undertreated. A retrospective chart review was conducted to determine the clinical characteristics and treatment practices of lymphoedema in a Canadian wound care clinic., Method: Data were collected retrospectively from dictated clinic notes of 326 lymphoedema patients at a wound clinic in a regional rehabilitation hospital., Results: The mean age (±SD) of diagnosis was 66.8 (±15.5). Patients had 7.3 (±3.3) comorbidities and took 8.4 (±4.6) concomitant medications. The most common comorbidities were venous disease (73%), hypertension (60%), and obesity (46%). Clinic patients were less likely to be women, have arm lymphoedema, or have cancer-related aetiology compared with previous studies, reflecting a two-tiered model of care delivery in the area. Treatments prescribed by the clinic were consistent best practice recommendations for conservative treatment., Conclusion: A significant proportion of the wound clinic's patients had lymphoedema. Lack of resources, lack of awareness among primary care providers, and patient adherence are barriers to lymphoedema care.

Objective: Late-stage lymphoedema is characterised by chronic swelling, shape distortion, inflammatory processes and tissue fibrosis. Our aim was to perform a clinical audit of a lymphoedema compression bandaging system (Rosidal Soft foam roll layer and figure-of-eight application of Actico cohesive inelastic bandages) specifically designed for patients with late stage lower limb lymphoedema., Method: The audit explored suitability of the bandaging system, benchmarking limb volume changes with research evidence, and reporting patient and practitioner evaluations., Results: A mean reduction (33%) in excess limb volume was reported for the 11 patients with unilateral lymphoedema who completed a course of bandaging over 12 days. Mean percentage reduction of absolute limb volume after treatment was 8%. Patient and practitioner evaluations indicated the suitability of this bandage system for patients with late stage lymphoedema in terms of comfort and effectiveness., Conclusion: The bandaging system is suitable for patients with late stage chronic swelling. Two parameters for calculating change in limb volume are not interchangeable. Future evaluation of the bandaging system, using validated outcome measures within a comprehensive research study is required., Declaration of Interest: Activa Healthcare provided financial support to the project and supplied the materials.

To achieve good patient outcomes, clinicians must ensure that clinical decision making is informed by valid and reliable evidence. This review examines the evidence on the clinical efficacy and reproducibility of compression applied by the KTwo bandage system. Its aim is to describe the evidence, not critique it. However, it clearly shows there is a body of evidence, from simple comparative evaluations to a randomised controlled trial, demonstrating the effectiveness of this system

Chronic oedema of all causes is thought to be more prevalent than studies have shown. The impact of this chronic condition encompasses many physical, psychological and social domains, many of which are not acknowledged nor addressed. Successful management relies on three factors. The first is early detection and commencement of treatment to prevent complications occurring. The second is an holistic multidimensional approach to address all the associated physical, psychological and social sequellae. Finally, collaboration between specialist and generalist health professionals is essential to ensure the best treatment is delivered in the best healthcare location. To achieve these there needs to be a network of suitably qualified practitioners who are upskilled by robust awareness and education systems, all of which should be supported by stable financial and human resources.

The introduction of social enterprises into healthcare has brought about opportunities and challenges for providers and clinicians. Dudley Lymphoedema Service, a team originally of five staff members, has undergone radical changes. The team has successfully gone through the Department of Health's right to request programme to move from a primary care trust service to become a social enterprise, LymphCare UK, which is a community interest company. There are only approximately 40 NHS services throughout the country that have taken this option as part of government changes and plans to put clinicians at the helm of services. Becoming a social enterprise has led to the service becoming bespoke, more responsive, flexible and innovative. Stepping out of the NHS has not been an easy journey but is one that the team is confident will improve outcomes for the organisation and the patients it serves.

This article will focus on the evidence to support the treatment of a palliative patient who was diagnosed with cancer-related secondary lymphoedema. A case study approach has been adopted, which focuses on the anatomy and physiology of lymphoedema and how this is treated through an analysis of the treatment regimens. To establish the effectiveness of these treatment regimes, the use of objective and subjective tools will also be analysed to ascertain their importance within care. The findings of this case study and the supporting evidence indicate a positive correlation between the use of lymphoedema treatment methods in both limb volume reduction and quality-of-life outcomes. However, robust evidence is required to expand the importance of each treatment used in the area of lymphoedema management.

Actico has been used successfully within clinical and community settings and is best used as part of a multi-layered lymphoedema bandaging (MLLB) system. This system is designed to produce a semi-rigid casing that is comfortable enough to allow patients to continue with their activities and exercises so as to generate an optimal resisted muscle pump action within. Correct application is key to using this cohesive short-stretch bandage, and collaborative working between clinics and community nurses is made easier through using Actico as part of oedema management. The case studies enclosed aim to illustrate the use of Actico MLLB for both patients and clinicians.

Lymphoedema is a very distressing chronic condition prevalent in some metastatic cancers. Conservative treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using manual lymphatic drainage (MLD), compression therapy (bandaging and/or garments), skincare, and remedial exercises, adapted to the needs of the patient. The aim of this service development project was to identify current practice in a hospice palliative care service, develop new assessment tools, and implement a collaborative clinical protocol to improve access to lymphoedema management for patients in the hospice. Two audits provided new evidence about patient profiles, patient assessment, and treatment outcomes for cancer- and non-cancer-related lymphoedema. This project had a quality-improvement effect on service delivery and developed an effective partnership approach to lymphoedema management between local district nursing services and the specialist lymphoedema physiotherapist.

The management of chronic oedema is a continuing partnership between patient and practitioner and accurate diagnosis and treatment planning are essential to control the condition in order to prevent complications and optimise the patient's quality of life. A paucity of funding, lack of knowledge and confidence on the part of practitioners and widely varying access to services means that many patients face barriers to gaining appropriate treatment. Nurses in many spheres will come across patients with some form of chronic oedema. The following article describes the types and causes of chronic oedema and lymphoedema and explores the use of compression hosiery as one facet in management of the condition. Patient education and the role of the practitioner are also highlighted to develop awareness of the need for adequate preparation of a patient to facilitate concordance and self-management of their condition.

Lymphoedema in children is rare and poorly recognized. Children with lymphoedema have great difficulty accessing appropriate services and treatment. The long term global consequences of living with this incurable condition are under-estimated. This article outlines the causes, effects and treatment of lymphoedema in children. Recommendations are made that all children with lymphoedema should be referred to a lymphoedema specialist as soon as swelling develops.

The problems associated with lymphoedema can be devastating, particularly for patients with lymphoedema and advanced disease. All lymphoedema treatment is palliative in nature as the underlying condition is incurable; however, much can be done to relieve the symptoms associated with the oedema. It is important to remember that the burden of treatment on the patient should not exceed the benefit gained and, therefore, treatment may have to be adapted and modified to suit patients individual needs. This article describes the classification, aetiology and nursing management of lymphoedema with an emphasis on the management of lymphoedema in the patient with advanced disease.

Lymphoedema is a condition where there is an obstruction of the flow of lymph, partnered with a swelling of the limb. Within the breast cancer arena lymphoedema can occur in the arm where the cancer was/is. The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), or even surgery. This article will discuss the treatments for lymphoedema along with relevant evidence and illustrate current practice.

Lymphoedema is a common problem affecting at least 100,000 people in the United Kingdom. There is a lack of knowledge among healthcare professionals regarding lymphoedema and this has led to the condition often not being recognized early enough or being adequately managed. Lymphoedema is an incurable condition which will progress if it is not appropriately treated. Physical problems associated with lymphoedema may include pain, discomfort, heaviness of the limb and distortion in limb shape and size leading to reduced mobility and function. This has implications for lymphoedema patients who may experience a significant reduction in their quality of life because of this condition. Treatment, if commenced early, is straightforward and patients can be taught to carry out an effective programme of daily self-care. If, on the other hand, the lymphoedema is not recognized early or not properly treated, it can develop into a serious and highly debilitating condition.

Lymphoedema and chronic venous insufficiency with venous leg ulceration have long been viewed as distinctly separate entities. This article explores how toe bandaging, a skill used routinely in lymphoedema practice, might benefit people being bandaged to treat venous leg ulcers. A small research study identified that 12 out of 124 people receiving high compression bandaging for venous leg ulcers without toe bandaging developed toe ulceration during a 2-year period. A second study has found no episodes of toe ulceration in patients receiving toe bandaging as part of their care. Unfortunately, there was significant heterogeneity between the two trials in terms of the client group, duration of bandaging and bandaging techniques, meaning that firm conclusions could not be extrapolated. A brief discussion of the pathophysiology and bandaging techniques used for lymphoedema and venous leg ulcers is used in this article to try and explore the rationale behind whether to bandage the toes or not, and to try and help practitioners decide whether toe bandaging should become part of all compression bandaging regimens.

Lymphoedema is a progressive and debilitating disorder, caused by malfunction of the lymphatic system. It is characterized by chronic swelling, usually of a limb but it can also affect other parts of the body. It is not curable but can be reduced and controlled. The mainstay of management is physical decongestive treatment, of which compression therapy is one of the four elements. The simplest and most cost-effective method of applying compression is with elastic compression garments. Essential for their success are a perfect fit and appropriate selection of compression class and stocking material. Elvarex, manufactured by JOBST, is a range of custom-made compression garments for both upper and lower limbs, available in a wide variety of styles and options. The flat knitting process provides superior fit and effective long-term management of lymphoedema.

The aim of this study was to develop an understanding of the patient's experience of a course of manual lymph drainage (MLD for cancer-related lymphoedema. The study used an interpretative approach. Six patients took part in unstructured interviews with the researcher 1 month after a 3-week course of daily MLD, provided by a trained MLD therapist. The researcher also recorded personal observations and thoughts throughout the study period. A number of themes emerged from the data illustrating patients' hopes and expectations regarding MLD. These were often linked with a desired response to treatment. Feelings of relaxation and calm during and after daily MLD were described and the treatment was also found to allow patients time-out to sleep, think or reflect. This small study adds to the limited body of knowledge about MLD and will help lymphoedema therapists identify how this treatment may influence the care of their patients and how resources could be allocated in its future provision.

Compression gradient wrap sleeves are an alternative to bandages in controlling lymphoedema, but there is very little data on the effectiveness of these products. This small study examined their effect on compliance and patient outcomes.