Lymphoedema post burns: A review

Evania Lok¹, Sally Ng²,
¹Austin Health, Melbourne, Victoria, Australia
²Alfred Health, Melbourne, Victoria, Australia

Abstract

Secondary lymphoedema is a rare and under-reported complication following a burn injury. The compounding pathological insult of a burns local soft tissue injury combined with the integumentary changes associated with chronic lymphedema can have significantly morbid functional outcomes. It is well understood that a large surface area burn will disrupt superficial lymphatic drainage however the impact on deep lymphatic function is unclear. Reports of post burns lymphoedema are limited to three case reports involving the upper and lower extremities and an epidemiology study identifies its prevalence as 1% however this is limited by its small cohort size. Considering the prevalence of thermal injuries in Australia, the under-reporting of post burns lymphoedema is likely a reflection of its diagnostic difficulty. It remains an area in need of consensus and objective measurement to identify and define its scope within clinical practice. Reported management of documented cases have relied on conservative compression therapy despite noted advances in the surgical management of secondary lymphoedema. These have traditionally encompassed several techniques which bypass the site of lymphatic obstruction by direct lymphatic anastomosis or node transfer. Recently the concept of lymph-axiality has been explored to restore lymph flow without supermicrosurgery by establishing lymph flow direction during free flap surgery. Orientating the flap lymphatics in line with the recipient site can help re-establish lymphatic flow. The potential of burns resurfacing with soft tissue and simultaneously reducing risk of developing lymphoedema is one to explore especially as operative intervention for post burns lymphoedema has not yet been described and remains a topic ripe for practical application.

Biography

Evania Lok is currently a research registrar at Austin Health who has worked as a Plastics Registrar across Victoria.