Chronic Oedema

Summary for patients:

Oedema is the medical term for when fluid builds up in the body, usually the legs, causing swelling and discomfort. It is often caused by an underlying medical condition and clears up when this is diagnosed and treated. However, if it persists for more than three months and does not improve when the limb is elevated, it is called Chronic Oedema. Often people with leg ulcers will suffer from Chronic Oedema. The condition is improved by compression bandaging the affected area and then using compression stockings.

For health practitioners:

Oedema is the build-up of fluid in the interstitial spaces and is commonly present in the lower limbs due to the effect of gravity.1 It is the most obvious sign of sustained venous hypertension as a result of Chronic Venous Insufficiency (CVI).2 CVI is usually caused by primary varicosities or post-thrombotic syndrome, which leads to vein dilation and damaged valves. This causes venous reflux and the resulting venous hypertension changes the permeability of the vein walls, allowing excess fluid to be pushed into the extra-vascular tissues.

In normal circumstances, the extra fluid is taken up by the lymphatics and returned to the circulation system. However, continuous high levels of extra tissue fluid, compounded by other complicating factors (such as infection, sustained increased venous pressure, immobility and obesity), can overwhelm the lymphatic system causing the limbs to become swollen and distorted.

Chronic Oedema is the term used to describe oedema which has been present for at least 3 months and does not reduce when the limb is elevated.3 Local damage to the lymphatic capillaries can occur if left unchecked, which can lead to thickening of the tissues, dermatological changes and eventually Secondary Lymphoedema. A significant number of patients with leg ulcers suffer from Chronic Oedema.4

Managing Chronic Oedema is essential to healing any co-existing ulcer and compression bandaging is considered the most effective treatment for reducing levels of oedema and improving both lymphatic and venous functions.5

Evidence shows that inelastic bandages are the best option for reducing oedema levels.6 However, it has been shown that management of oedema is improved when bandaging is followed by compression hosiery.7

References
  1. Moffatt C. Compression therapy in practice 2003
  2. Mortimer P, Levick JR (2004) Chronic peripheral oedema: the critical role of the lymphatic system; Clinical Medicine 4(5): 488-53.
  3. Green T, Mason W (2006) Chronic oedemas: identification and referral pathways. Br J Comm Nurs 11(4): S8–S16
  4. Moffatt CJ, Franks PJ, Doherty DC, Martin R (2004) Prevalence of leg ulceration in a London population. QJM 97: 431–7
  5. Földi M, Junger M, Partsch H (2005) ‘The science of lymphoedema bandaging’. European Wound Management Association Focus Document. Lymphoedema bandaging in Practice. MEP Ltd, London: 2–4
  6. Partsch H (2005) The static stiffness index: a simple method to assess the elastic properties of compression material in vivo. Dermatol Surg 31: 625–30
  7. Badger CMA, Peacock JL, Mortimer PS (2000) A randomised, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphoedema of the limb. Cancer 88(12): 2832–37