BACKGROUND: Burn injuries and the disease process of lymphedema are complex medical conditions involving the integument. The possibility of a relationship between burn injury and the development of lymphedema was studied. METHODS AND RESULTS: The incidence of lymphedema was explored by conducting a 5-year retrospective chart review on edema related ICD-9 codes. The prevalence of lymphedema was assessed in a prospective study of patients in a burn clinic. The techniques used to diagnose lymphedema were utilized on all patients presenting to clinic with extremity edema. The prospective analysis reviewed the lymphedema tests and measures and burn characteristics to determine those that were appropriate to diagnose or predict the risk of lymphedema in a burn patient. A 6-month follow-up study was also conducted to re-examine subjects initially diagnosed with lymphedema. CONCLUSIONS: The retrospective review did not reveal significant findings to determine incidence of lymphedema following burn injury. The prospective study identified eight patients with a clinical diagnosis of lymphedema. Two of the eight subjects had a previous diagnosis of lymphedema prior to the burn injury. The six remaining subjects represent a prevalence of 1.0%. Specific tests and measures, Stemmer Sign, deepening of skin folds, and the lack of venous alterations, were found to be appropriate measures to diagnose lymphedema in the burn patient population. Specific burn characteristics, circumferential extremity involvement, and fascial excision, also identified burn patients who may be at risk for developing lymphedema. Lastly, the results of the 6-month re-evaluation confirmed the original diagnoses.
BACKGROUND: Burn injuries and the disease process of lymphedema are complex medical conditions involving the integument. The possibility of a relationship between burn injury and the development of lymphedema was studied. METHODS AND RESULTS: The incidence of lymphedema was explored by conducting a 5-year retrospective chart review on edema related ICD-9 codes. The prevalence of lymphedema was assessed in a prospective study of patients in a burn clinic. The techniques used to diagnose lymphedema were utilized on all patients presenting to clinic with extremity edema. The prospective analysis reviewed the lymphedema tests and measures and burn characteristics to determine those that were appropriate to diagnose or predict the risk of lymphedema in a burn patient. A 6-month follow-up study was also conducted to re-examine subjects initially diagnosed with lymphedema. CONCLUSIONS: The retrospective review did not reveal significant findings to determine incidence of lymphedema following burn injury. The prospective study identified eight patients with a clinical diagnosis of lymphedema. Two of the eight subjects had a previous diagnosis of lymphedema prior to the burn injury. The six remaining subjects represent a prevalence of 1.0%. Specific tests and measures, Stemmer Sign, deepening of skin folds, and the lack of venous alterations, were found to be appropriate measures to diagnose lymphedema in the burn patient population. Specific burn characteristics, circumferential extremity involvement, and fascial excision, also identified burn patients who may be at risk for developing lymphedema. Lastly, the results of the 6-month re-evaluation confirmed the original diagnoses.
Authors: Shayna L Showalter; Justin C Brown; Andrea L Cheville; Carla S Fisher; Dahlia Sataloff; Kathryn H Schmitz Journal: Ann Surg Oncol Date: 2012-10-03 Impact factor: 5.344