Literature

This Journal of Wound Care supplement on genital lymphoedema addresses this under-reporting of genital oedema by using a holistic framework through three papers written by authors from five different parts of the world and presenting research from different professions working in varied specialist areas.

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A position document on compression bandaging – This position document on compression bandaging is the first of a series of in-depth documents on aspects of lymphoedema practice and contributes to the second edition of the best practice document. It draws together the current evidence base supporting compression as well as celebrating the wealth of international variation in the way in which compression bandaging is used in clinical practice. Most importantly, it includes how the challenges of bandaging are tackled in resource-poor countries such as India, a feature that was not present in the first edition. The document has been supported by an international editorial board and peer review that includes experts in compression therapy to ensure that, in addition to presenting the state of the art in compression, it is clinically useful for practitioners.

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A position document on surgery for lymphoedema – This position document on the role of surgery in lymphoedema management forms part of the second edition of the International Lymphoedema Framework (ILF) best practice document. The ILF are very proud that this document is based on a systematic review of surgery in lymphoedema management undertaken by the American Lymphoedema Framework Project; the chapter by Dr Janice Cormier summaries their findings and recommendations. This approach follows that of the first edition of the best practice document that began with Cochrane systematic reviews of physical therapies.

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The way forward – The International Lymphoedema Framework (ILF) was established as a charity in the UK in 2009. Its aim is to improve the management of lymphoedema and related disorders worldwide, by sharing expertise and resources and supporting individual countries to develop a long-term strategy for lymphoedema.

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This focus document provides practitioners with an overview of childhood lymphoedema: the causes, presentations, and approaches to management.

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The LSN was asked to write our ‘story’ to inform and encourage international groups within the ILF community. This is not to imply that we know it all, always get it right, or that we have completed our work, as none of these things are true. But, what is true is that the hard work, dedication and expertise of everyone involved in the organisation since it began in 1991 has seen the LSN grown from a group of seven members with big ideas, to the UK’s leading lymphoedema charity, still with big ideas!

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This template follows on from the first document, Compression hosiery in lymphoedema (Lymphoedema Framework, 2006a) that recognises the central role that compression garments play in the treatment of lower limb lymphoedema. Together they provide a comprehensive, yet practical guide for practitioners who are managing patients with lymphoedema.

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In many countries, the provision of care for patients with lymphoedema is inadequate, often as a result of under-recognition of this chronic debilitating condition of highly diverse aetiology. Historical influences on service development have in some cases resulted in inequity for certain groups of patients and in approaches to healthcare provision that are not necessarily relevant today. Growing recognition that lymphoedema has causes other than cancer and recent changes in healthcare priorities necessitate a fresh approach to lymphoedema service provision.

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Lymphoedema is a progressive chronic condition that affects a significant number of people and can have deleterious effects on patients’ physical and psychosocial health. Even though it may be greatly ameliorated by appropriate management, many patients receive inadequate treatment, are unaware that treatment is available or do not know where to seek help. Several recent systematic reviews have highlighted the distinct lack of evidence for the optimal management of lymphoedema. By presenting a model for best practice in lymphoedema in adults, this document aims to raise the profile of the condition and improve the care that patients receive.

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The position document aims to provide the clinician with approaches to the management of oedema and its associated complications at the end of life. Specialist therapeutic interventions, embedded in the pallative care ethos of multidisciplinary care to reduce symptoms and associated psychological distress, improve quality of life and reduce attendant risks, are defined.

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This issue, Compression Hosiery in Lymphoedema, recognises the central role that compression hosiery plays in the treatment of lower limb lymphoedema. The guidance provided is a synthesis of work undertaken by the Lymphoedema Framework with patients, clinicians and industry.

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