Managing Lymphedema in Fracture Care: Current Concepts and Treatment Principles

Abstract

Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.

A novel therapy for fracture healing by increasing lymphatic drainage

“…In addition, prompt treatment of pain, widely-regarded as the fifth vital sign, is beneficial for reducing suffering, readmissions and emergency department visits after hospital discharge [ 36 ]. Although many studies have reported on how to eliminate chronic post-traumatic lymphedema [ [37] , [38] , [39] ], the effect of lymphatic drainage on acute post-traumatic hematoma and pain is not clear. With the treatment of anti-PDPN neutralizing antibody, we determined that improving lymphatic drainage reduces acute post-traumatic edema and pain, suggesting that defects in lymphatic drainage plays a key role in the early complications of traumatic fracture.…”

Post-traumatic lymphedema: review of the literature and surgical treatment options

“…Injuries to bone and soft tissues are usually followed by edema, which develops immediately after soft tissue injury or fracture [6] . Unlike edema from chronic venous obstruction, post-traumatic edema presents with pain at the site of injury, erythema, and increased skin temperature.…”

“…Unlike edema from chronic venous obstruction, post-traumatic edema presents with pain at the site of injury, erythema, and increased skin temperature. These clinical findings are indicative of a protracted inflammatory reaction characterized by immune cell infiltration and activation of an inflammatory cascade [6,7] .…”

“…A prospective study of 21 patients with post-traumatic lower extremity edema demonstrated dilated lymphatics with the decreased lymphatic flow on lymphoscintigraphy [6] . Minor trauma, however, seldom leads to chronic lymphedema.…”

Lymphedema as Consequence of Loxosceles Brown Spider Bite: A Case Report and Literature Review

“…Anatomically, most peripheral superficial lymphatic vessels of the lower leg run along the way of the medial face of the limb, parallel to the superficial great saphenous vein [21] damage, chronic inflammation, and trauma to this specific anatomic area contribute to the development of secondary lower limb lymphedema [22][23][24][25][26]. This site was exactly the spider bite site, where local loxoscelism was developed, where the skin and soft tissue destruction happened to be; the epicenter of the chronic inflammatory process caused by the wound, and where recurrent lymphangitis originated.…”