Friday, December 23, 2005

Lymphedema and Lymphorrhea

Definition of Lymphorrhea?

Lymphorrhea is the light amber colored fluid that drains from open skin areas (wounds) on a lymphodemous limb. It is not normal plasma, but is a protein-rich substance that can lead to serious complications for the lymphedema patient. The composition of lymphorrhea is approximately 1.0=5.5 g/ml of protein.

Causes of Lymphorrhea

The cause of lymphorrhea drainage is any open area or break in the skin of the lymphodemous limb. Any opening, no matter how small will cause this fluid to weep or drain. Insect bites, cuts, abrasions, cracks in the skin from dryness, wounds of any type become a source for leakage of this fluid.

Lymphorrhea Complications

There are two serious complications that arise from lymphorrhea.The fluid is a natural "food-source" for bacteria. The open draining wound becomes what is referred to as an entry foci for bacteria. This leads to cellulitis, lymphangitis or erysipelas.Lymphorrhea is highly caustic to the skin tissue that it come into contact with. Untreated wounds with this drainage can very quickly become large gaping areas that may eventually lead to the need for skin grafts.

For further information on lymphorrhea and wounds associated with lymphedema see our Wounds section.



Lymphorrhea - What Is It

Lymphorrhea is an escape of lymph from a cut, torn, or burst blood vessel onto the surface of the skin. Lymph is a milky fluid that contains proteins, fats, and white blood cells (which help the body fight off diseases). Blood vessels are tube shaped structures that carry blood to and from the heart. Lymphorrhea is also known as lymphorrhagia. Lymphorrhea comes from the Greek word "lympha" meaning "spring water," and the Greek word "rhoia" meaning "a flow." Put the words together and you have "a flow (of) spring water."


This article is taken from the Winter 2002 issue of LymphLine


By LSN Trustee and Nursing Advisor, Denise Hardy

What is Lymphorrhea?

Lymphorrhea is the leakage, or weeping, of lymph fluid through the skin surface. Large beads of fluid appear on the skin and trickle from the affected areas.

Causes of Lymphorrhea

May be the result of lacerations, abrasions, or trauma of the altered dry skin of longstanding edema e.g. graze/cut

It may result from the rupture (bursting) of lymphangiomas (described more fully below)

It may also occur in a sudden or acute edema (swelling) where the shiny, taut skin has stretched so rapidly that it splits, forming a leak.

Lymphorrhea - the complications it causes

The skin feels very cold, wet and uncomfortable. The fluid can soak through dressings which may need changing many times a day to cope with the large amounts of leakage The fluid can collect in shoes/slippers… clothing and bed linen can become soaked and require frequent changes

Lymphorrhea will increase the risk of cellulitis - the break in the skin acts as an entry for bacteria. Infection will cause further problems (pain/inflammation/flu-like symptoms and increased amounts of fluid leakage)

If left to leak and dressings are not regularly changed the lymph (being an excellent culture medium) may grow bacteria causing odor and discoloration

Lymphorrhea may cause social difficulties and embarrassment.

Lymphorrhea not uncommonly affects the genital area and may be difficult to distinguish from urinary incontinence.

Treatment of Lymphorrhea

In order to stop the fluid leaking, a series of steps are essential.Your Lymph edema nurse/therapist or other nurse involved in your care should be able to help you with these steps following a full assessment of the cause of the leakage:

The area around the 'leak' needs to be cleaned carefully to ensure the risk of infection is reduced.

An emollient (moisturizing cream/lotion) should be applied to the skin to improve the condition and protect it (by acting as a barrier) against further skin breakdown.

A non-adherent (non sticky), absorbent, (e.g. Allevyn/Cutinova/lyofoam) sterile dressing should be applied to the leaking area to prevent further trauma to the skin - and to absorb the leakage.

Pressure should be applied. For example a limb should be supported with appropriate bandaging e.g. Multi Layer Lymph edema Bandaging (MLLB) with short stretch compression bandages. This normally stops the flow of leakage within 24-48 hours. Bandages may have to be replaced frequently during this period of time to remove wet bandages/ dressings and to prevent further skin breakdown. MLLB should continue until the skin condition has improved enough to wear your stockings/sleeve again.

At rest, the affected limb should be elevated to reduce the effects of gravity.

Once the leakage has stopped, and the skin condition has improved, your usual compression garment should once again be applied. The garment will keep the swelling to a minimum and prevent any further 'leaks' appearing.


Stopping Lymphorrhea and Treating the Wound

Treatment of Superficial Wounds on a Lymphodemous Limb I learned a wonderful technique from a wound clinic several years ago. This is excellent for superficial wounds.I use a very simply, but effective ointment. Desitin with zinc,thats right baby diaper ointment.Cover the wound with ointment and place several pieces of square gauze over it. Wrap the affected part of the limb with rolled gauze and then wrap around that with an elastic bandage. Wrap firm but not over tight, using a criss cross method (figure eight).NOTE: This is for superficial wounds only. If the wound does not clear up within a few days, consult your doctor. You must also see your doctor immediately if it is a large wound or injury or if there begins to be inflammation or infection.Sometimes, you may even need to go to a Wound Clinic. I have found them to be wonderful and very helpful.

Lymphedema Wounds

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