British Lymphology Society's position paper for management of people with lymphoedema in presence of deep vein thrombosis: a summary.

There is some confusion surrounding the management of people with lymphoedema in the presence of deep vein thrombosis (DVT). This may be in relation to the suitability of commencing compression therapy or regarding the continuation of compression therapy in those who develop DVT. The purpose of this British Lymphology Society position paper is to support evidence-based practice and debunk the myths surrounding the management of DVT and lymphoedema.

Making Legs Matter: A Case for System Change and Transformation in Lower-Limb Management.

This consensus document is endorsed by The Queen's Nursing Institute (QNI) and The Queen's Nursing Institute Scotland (QNIS).

Use of upper-limb compression garments in the management of lipoedema.

Compression hosiery is commonly used for the management of lymphoedema as well as lipoedema, but it is more commonly indicated for the lower limbs than for the upper limbs. The effects of compression hosiery on upper-limb lipoedema are poorly understood and researched. It is known that compression hosiery works in conjunction with activity or movement when standing or walking, which produces anti-inflammatory and oxygenating effects in the tissues. This effect is naturally difficult to realise in the upper limbs. Lymphoedema practitioners who treat those with lipoedema should bear in mind that compression treatment might not produce the same effects in upper-limb lipoedema as it does in lower-limb lipoedema. In these times of an overstretched health service, pragmatic resource use is essential.

Production of the electronic British Lymphology Society Red Legs Pathway.

Antibiotic misuse is a rampant problem the world over and it in turn leads to other issues, the main one being the rise of antibiotic-resistant microorganisms. Often, bilateral red legs are mistaken for acute cellulitis, an infection of the skin, and are inappropriately treated with antibiotics. The British Lymphology Society's Red Legs Pathway aims to support differential diagnosis in patients with bilateral red legs to enable prompt and effective management and improve patient experience. The pathway also aims to reduce inappropriate use of antibiotics and potential negative consequences. This article provides a brief outline of the pathway and its development.

Introducing the British Lymphology Society position paper on ankle brachial pressure index.

Prompt application of appropriate compression therapy is essential for effective treatment of lymphoedema. However, it is accepted that prior to the application of compression to the lower limbs, either with bandaging or compression garments, patients should demonstrate a satisfactory vascular status, as assessed via axillary brachial pressure index (ABPI). Unfortunately, the presence of peripheral oedema may render a reading impossible or grossly inaccurate. Relying solely on ABPI assessment is potentially harmful to patients, who may be denied appropriate treatment or experience complications and deterioration of their condition due to delayed treatment. The British Lymphology Society recognises a need to focus more on clinical assessment skills to determine vascular status, rather than relying on ABPI alone. Thus, the Society has developed guidance and a practical tool to support clinical decision-making and enhance practitioner confidence in the safe application of compression therapy in the absence of ABPI.

Impact of JOBST® Elvarex® knee and elbow functional zones on quality of life.

Lymphoedema results from a failure of the lymphatic system. The consequences are swelling, skin and tissue changes and predisposition to infection. Lipoedema, however, results from the predisposition of an excessive number of fat cells in the lower limbs, typically from the ankle to the waist. Management for lymphoedema consists of volume reduction, reduction in shape distortion and improvement of skin condition. Treatment consists of a two-phase approach including an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments. Case studies are presented featuring lower limb lymphoedema and upper limb lymphoedema and a patient affected by lipoedema. The case studies demonstrate how JOBST Elvarex custom-fit, flat-knit compression garments with knee and elbow functional zones enhances patient choice, garment suitability and potential for improved quality of life.

The management and treatment of hyperkeratosis.

Rebecca Elwell, Macmillan Lymphoedema Advanced Nurse Practitioner, Royal Stoke University Hospital, discusses recommendations on management of this skin problem, which may co-occur with chronic oedema.

Managing chronic oedema and venous disease with made-to-order garments.

Selecting the most appropriate compression garments is vital in the long-term management of venous disease and chronic oedema. The range of styles has improved greatly over the years and many garments are available on the UK Drug Tariff. Practitioners now have a wide range of options to choose from including the type of fabric, colour, compression class, and style of garment. These options increase the pratitioner's ability to select the most suitable garments and combine clinical and aesthetic needs, with the ultimate aim of improving compliance. The focus of this article is to highlight the aims and qualities of the various types of compression garments available, discuss the rationale for prescribing choice, and describe the benefits of Haddenham's Veni made-to-order compression leg garments in the management of chronic oedema and venous disease. Three case studies will demonstrate the effectiveness of the Veni made-to-order range of compression garments.

An overview of the use of compression in lower-limb chronic oedema.

Chronic oedema in the lower limbs can be a debilitating condition and has a negative effect on a patient's quality of life. As yet, there is no known cure for this condition; however, it can be controlled and managed, and its recurrence can be prevented. One of the most common and successful ways of managing this condition is the use of compression hosiery. With an expanding knowledge base of compression hosiery, lymphoedema specialists are now able to address historical problems of poor fit and concordance. Moreover, there is a wide choice of garments available today for clinicians to use, that not only help to control and treat the oedema, but have also improved patients' quality of life because the garments are comfortable and inconspicuous. Evidence has shown that concordance is greatly increased when patients participate in their treatment and help to decide on the most suitable garment for themselves. This article gives an overview of the use of compression garments when treating lower-limb chronic oedema in patients, and explains the aspects to bear in mind when choosing and prescribing compression hosiery.

Developing a nurse-led 'red legs' service.

As the population ages, more complex care is required to manage multiple comorbidities. In response, a nurse-led service was developed to care for patients with 'red legs'. This chronic inflammatory condition is often misdiagnosed as acute cellulitis and can result in unnecessary hospital admission and inappropriate treatment, with substantial resource and financial implications for trusts. Setting up the service required a multi-agency group to analyse current provision and identify gaps in care. Integrated care pathways were developed to focus on patient experience through referral, diagnostics and treatment. Evaluation showed that much of the prescribed care for patients with red legs could be carried out by patients at home and only a small number required a follow-up appointment. High levels of patient satisfaction were recorded.