MLD when cellulitis present?

katbob

I have progression in underarm as well as upper arm area and new skin mets to chest wall.  Just started on antiobiotic for cellulitis today.  Wondering if I should be doing MLD, wrapping, or anything.  Afraid I will lose complete control of the swelling if I do nothing, as it has been hard lately to get the swelling down even with leaving it wrapped most of the day. I have pitting edema as well in hand and arm.  Does lymphedema ever present as pitting edema?

 I have a great LE therapist, but she is on extended sick leave. Looking for opinions from this group.  Any ideas would be greatly appreciated!

Anonymous

Hi katbob, I dont know a lot about this, but Im sure its recommended that you DONT do MLD when theres cellulitis. You might want to hold off until someone confirms that. In the meantime Gentle HUGs and Im going through the pitting edema thing too. Yes I think it is part of it. Obviously theres much more I need to find out....

Hope you ditch that dang cellulitis ASAP.

kira66715

Lymphedema definitely presents as pitting edema--it's one of the first signs of it.

When people have cellulitis they are classically told not to compress or do MLD, but I looked it up in the International Best Practices, and the recommendation was for a loosely wrapped arm to control swelling but not to keep the antibiotics out, and to hold on MLD until the infection was getting under control.

I think we put it on SUSO:we did! (thanks to Jane our amazing webmaster)

http://www.stepup-speakout.org/Emergencies_and_Medical_Care_lymphedema.htm#compression

Special Considerations for Cellulitis with Lymphedema: When to Use Compression with Infection

1) The illness can become very severe very quickly: it is advised that people with lymphedema have antibiotics on hand to start at the first sign of redness, warmth, fever, pain and then seek appropriate medical care

2) The infecting organism can be unusual: recently a woman grew group B strep, usually associated with immunosuppression

3) Stagnant lymphatic fluid functions like an abscess: abscesses require drainage and cellulitis with lymphedema requires gentle compression to remove the infected fluid

4) Compression in lymphedema associated cellulitis: the "common belief" is to avoid all compression and manual lymphatic drainage. A literature search did not reveal any studies to support that belief, the only literature addressing compression and MLD in cellulitis associated with lymphedema comes from the International Best Practices Guidelines. The literature search did again confirm that infection harms lymphatics so prompt and successful treatment is crucial.

5) Knowledge of bandaging is CRUCIAL: sleeves and night garments are unlikely to fit in the acute phase of lymphedema associated cellulitis, and only multilayered bandaging will allow the gentle and accurate compression to assist in the resolution of the infection without over-compressing and inhibiting antibiotics to reach the area.

Outfield states:  I'm back in a sleeve today, after wrapping most of the week.  My sleeve didn't fit when I first tried after the redness receded.  I only know how to wrap because I insisted on learning back when I was first diagnosed, and that was because I had read about it here and on the SUSO site.  My CLT didn't think I'd need to do it.  She thought a sleeve and a night garment would be enough for me (which they generally are).  I think she was a little annoyed to teach me.  But if I didn't know how to do it myself, I'd be waiting until sometime next month to get in for an appointment and I'd still be too swollen for my sleeve.

One patient reports being hospitalized for 12 days with cellulitis in her leg. In spite of using several antibiotics, nothing was working. A surgeon who was called in examined her leg and told the nurses to wrap it, but neither the nurses nor the physical therapist would wrap it, fearing the infection would spread up the leg. When the surgeon returned the following day he wrapped it himself with four bandages. That worked where the other interventions had failed, and the patient was released to go home with a PICC line the following day.

From the International Best Practices Guideline:

Commence antibiotics as soon as possible , taking into account swab results and bacterial sensitivities when appropriate

During bed rest, elevate the limb, administer appropriate analgesia (eg paracetamol or NSAID), and increase fluid intake

Avoid SLD (self MLD) and MLD (by therapist)

If tolerated, continue compression at a reduced level or switch from compression garments to reduced pressure MLLB (multilayered bandaging)

Avoid long periods without compression Recommence usual compression and levels of activity once pain and inflammation are sufficiently reduced for the patient to tolerate

Educate patient/carer - symptoms, when to seek medical attention, risk factors, antibiotics 'in case', prophylaxis if indicated

So, this is the best scientific advice/evidence we seem to have: avoid MLD in the acute phase, but resume light compression ASAP, and MLD can be resumed when the acute phase of infection is over.

carol57

Kira, you truly are committed to your quote about knowldge being the antidote to fear. What a wonderful, helpful, educational post! I learned something here.  Thanks so much, and to everyone at SUSO for filling in so many LE-knowledge blanks.

Anonymous

+1 to Carols post Kira. You are a truly an appreciated member here over and over again.  You deserve a medal.

kira66715

Jane and Binney asked me to help with SUSO, to put our hard earned knowledge in one place. I really needed to understand and process LE, and it was and is a group endeavor to capture the knowledge if the board. Thanks

katbob

Thanks so much for the info-I received a second dose of IV antibiotic today, and probably a third tomorrow as my onco is taking no chances-also on oral antiobiotic for 7 days.  I have seen improvement in the lymphedema as well in the past 24 hours.  I guess less is more in this case as I stopped the MLD for now, and will wrap loosely for a few days.  This is my first bout of cellulitis, and even though I was aware of possibility, I was surprised to have it!  Thanks again for all your responses-what a great resource.