Vacuum-assisted closure therapy modality of treatment for ulcers in lymphedema patients

Abstract

Background Lymphedema in the presence of ulcers and lymphorrhea inducing cellulitis hinders the quality of life and mobility of the patients, and might continue inducing severe infection that might result in life-threatening infection, both bacterial and fungal. Since the negative-pressure wound therapy is a recognized modality of wound healings in such a context as lymphedema, it might induce a remarkable withdrawal and decrease in lymphorrhea and lymph fluid, resulting in a decrease of girth and heaviness of the limb, thus improving the quality of life. Also, it helps in promoting wound healing of the ulcers by improving the blood supply of the granulation tissues. Patients and methods Patients with lymphedema and lymphorrhea, cellulitis and edema, and ulcers were subjected to negative-pressure wound healing for 1 month after excluding anemic, uncontrolled diabetics, ischemic, or those with a venous disease (reflux or deep venous thrombosis). Results In this prospective study, 23 patients were recruited, where 22 patients continued the protocol for four weeks, 14 females and nine males. The mean age was 53 years. No adverse effects were observed as a result of this technique. One patient lost to follow-up and did not continue the protocol; all 22 patients were satisfied regarding the quality of life and social well-being. The negative-pressure wound healing therapy reduced the diameter of the treated limbs by the withdrawal of lymph and complete cessation of lymphorrhea, and thus decreasing the cellulitis induced by the lymphorrhea on the surrounding skin and also markedly reduced the diameters and hence the heaviness of the lower limbs. Last but not least, all ulcers reduced in diameter and adequate clean granulation tissue developed in the vicinity of the ulcer. Moreover, 5 of 23 patients' ulcers were completely healed. Conclusion Vacuum-assisted closure therapy in the presence of lymphedema, ulcers, and lymphorrhea and cellulitis provides a reasonable methodology of treatment by suction of lymphorrhea, thus stopping it with the consequent stopping of high-protein lymphorrhea, resulting in improvement of cellulitis, and a decrease in girth and diameter of the lymphedematous limb. Last but not least, it markedly improves healthy granulation and epithelization, resulting in wound closure. Further studies to confirm the role of vacuum-assisted closure therapy in lymphedema in the presence of ulceration are recommended.