OEDEMA
Oedema particularly of the extremities responds very
well to pressure therapy. Oedema may be of any origin.
It may be
Congenital: Lymphatic or Venous
Post-traumatic: both in plastic surgery & orthopedic
practice---whether degloving injuries or fractures of
the limbs
Infections: both acute (cellulitis) or chronic (filarial,
osteomylitis etc.) Superadded infection as in diabetic
foot & varicose ulcers
Inflammatory: Both of the skin & of soft tissues
Post Mastectomy: Though seen less & less these days
with awareness for early detection & advances in treatment,
particularly surgery.
Most commonly seen oedema
is due to Lymphatic obstruction in India particularly
Filarial in origin which is more prevalent in Endemic
areas
Oedema is more common
to occur in lower extremity than that of the upper.
This is mainly because of gravity & comparatively poor
circulation in lower legs particularly in advancing
age.
Another common cause
of oedema is varicosity of long duration. It may be
due to superficial or deep venous system or both being
affected. A repeated venous ulcer with superadded infection
is a common cause of oedema of the legs.
Similarly diabetic ulcers
with repeated breakdown & infection create the similar
problem. More ever there is deficit circulation with
high diabetes.
Irrespective of the cause
of oedema, the continuous use of pressure therapy is
mandatory in keeping the oedema under check. The old
system of using elastocrepe bandages often seen with
traffic police (involved in long hours of standing)
is an outdated one. The application
of elastocrepe bandage if not done properly can either
lead to over pressure causing distal oedema or inadequate
pressure, which will be ineffective Hence the pressure
stockings are the answer for such cases. Irrespective
of the cause of oedema, the continuous use of pressure
therapy is mandatory in keeping the oedema under check.
LYMPH EDEMA
In Lymph
edema the cause of oedema is Lymph edema obstruction.
The commonest variety is filarial oedema much more prevalent
in endemic areas. It may be congenital or even post traumatic
particularly in degloving injuries of the extremities
when due lymphatic obstruction & associated with inadequate
venous drainage the oedema occurs. Oedema is more common
to occur in lower extremities than in upper because of
gravity and comparatively poor circulation in the lower
legs in advancing age. Oedema could be congenital as well
as venous in origin but these are infrequent occurrences.
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