Context: In 2012, the US wound registry estimated that the cost of managing chronic wounds in the United States exceeded $50 billion. A large percentage of these wounds are venous stasis ulcers of the lower extremity. Evidence suggests that adjuvant osteopathic manipulative treatment (OMT) may provide a benefit by reducing edema and subsequent healing times in venous stasis ulcers of the lower extremity. Objective: To determine whether a lymphatic OMT protocol improves wound healing rates among patients with lower-extremity edema. Methods: This pilot study was a nonrandomized before-after community trial of lymphatic OMT in patients with lower-extremity wounds and edema. Wound surface area measurements for the preliminary phase were obtained retrospectively. During the intervention period, patients received 10 minutes of OMT twice per week. The OMT protocol, which aimed to improve lymphatic flow, included myofascial thoracic outlet release, doming of the diaphragm, pelvic diaphragm release, popliteal release, and pedal pump (2-3 minutes of continuous pump) performed in sequence. Rates of wound healing were compared between the preliminary (standard therapy), intervention (standard therapy plus OMT), and follow-up (standard therapy) phases. Rates of change in edema (measured using leg volume) were evaluated during the intervention phase. A custom-designed questionnaire was used to assess patients' satisfaction with their treatment and confidence that its effects on their health were good. Results: Eight patients were included in the study. The wound surface area increased during the preliminary phase by a mean of 10 cm 2 /wk and decreased during the intervention phase by a mean of 4.9 cm 2 /wk. Patients' mean leg volume decreased during the intervention phase. Six patients were "very satisfied" with their treatment. Conclusion: The adjunctive OMT protocol may have reduced edema and reversed the trend of wound growth in patients with venous stasis ulcers. Edema reduction is a mainstay of current wound therapy, and any modality that decreases edema may subsequently decrease healing times.

Spontaneous renal hemorrhage is an uncommon entity with potentially serious consequences. We present a 68-year-old female with a three-day history of progressively worsening left-sided flank pain due to spontaneous left renal hemorrhage without a history of trauma or anticoagulation. The patient's symptoms improved with conservative management and she was discharged after several days of observation. However, the patient was readmitted the next day with progressively worsening pain due to hematoma expansion from active extravasation. On the second admission, interventional radiology successfully embolized the affected vessels and the patient improved rapidly. The hematoma decreased in size on followup exams but no etiology was discovered. Early arterial embolization may have improved outcomes in this case and we argue that it should be considered early in the management of all patients with spontaneous renal hemorrhage.

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