Rebecca is the Macmillan Lymphoedema Advanced Nurse Practitioner at the University Hospitals of North Midlands NHS Trust. She completed an Msc in Lymphoedema in 2012. In 2013 she opened the UKs only Red Legs clinic for patients with leg redness from a cause other than acute cellulitis. This has led to increased awareness of red legs and reduced hospital admissions. The Red legs pathway has been adopted by the British Lymphology Society (BLS) and endorsed by the National Legs Matter campaign.

She is a proud trustee of the BLS, a member of the BLS scientific committee, BLS children with lymphoedema special interest group and is the BLS annual conference organiser.

Presentation at The SoTV/EWMA 2024 Conference, London

The management of Lymphorrhoea (leakage of lymph through the skin) in cancer related lymphoedema

Learning objectives

After attending this session, persons will be able to:

• Identify lymphorrhoea in palliative care and cancer related lymphoedema
• Know how to implement simple management techniques for lymphorrhoea in palliative care and cancer related lymphoedema
• Recognise when onward referral is required and who to involve
• Recognise the importance of compression in the management of lymphorrhoea
• Have a greater understanding of the research surrounding the management of lymphorrhoea in palliative care and cancer related lymphoedema

Abstract

Introduction: Cancer related lymphoedema can cause skin changes. Lymphorrhoea (leakage of lymph through the skin) can be a consequence of untreated chronic oedema and a complication of leg ulceration (Chronic Oedema Wet Leg Pathway, 2022) which can increase the risk of further skin breakdown and the development of cellulitis. More importantly it can lead to poor patient experience.

Discussion: There are a number of challenges in managing lymphorrhoea, these include:

•  Correct identification of lymphorrhoea as the skin change particularly in the presence of co existing wounds

•  Knowledge and skills in managing lymphorrhoea and that compression is the mainstay of treatment

•  Ability to adapt treatment to individual circumstances depending on the disease status of the patient and the site and severity of the lymphoedema and the recognition of when onward referral is required and who to involve

Management strategies will be discussed via case studies highlighting the quality of life difficulties affecting shoes and clothing as well as how simple life changes can lead to an improvement of cessation of symptoms. The Chronic Oedema Wet Leg Pathway endorsed by the British Lymphology Society (BLS) will be discussed as well as novel techniques discussed in the literature.

Conclusion: Management of lymphorroea should be implemented in a timely fashion to achieve control and it is imperative that if lymphorrhoea has ceased, prevention of the development of further lymphorrhoea and the ongoing management of chronic oedema is undertaken.

Presentation at the Advances in lower limb and foot care study day

The management of cellulitis in lymphoedema

Abstract

Cellulitis is an acute spreading inflammation of the skin and subcutaneous tissues characterised by pain, warmth, swelling and erythema. Cellulitis is a common complication of lymphoedema with one study of its prevalence in those attending a specialist lymphoedema centre reporting that 37.6% had experienced at least one episode and 23.3% having had recurrent cellulitis (Vignes 2022). In individuals with lymphoedema, cellulitis may differ from cellulitis occurring in other clinical situations. Treatment may also need to be different depending on the site of lymphoedema. A Cochrane review and subsequent partial update concluded that it was not possible to define the best treatment for cellulitis in general based upon existing evidence (Kilburn et al 2010; Brindle et al 2019). The British Lymphology Society Guidelines on the Management of Cellulitis in Lymphoedema makes recommendations about the use of antibiotics for cellulitis in patients with lymphoedema and advises when admission to hospital is indicated. Prompt treatment is essential to reduce the risk of worsening symptoms and the development of life threatening conditions such as sepsis and to avoid further damage to the lymphatics of the affected part, which in turn may predispose to repeated attacks and increased swelling, skin and tissue changes.