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Case Study/Series
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Patient-centered strategies for managing lymphedema: A clinical case study First Author: Judy A Barry Authors: JA Barry, RN, KA Tweedie BA, RMT, MD Fierheller, RN, BScN, Ms (c) A 57 year old female (JA) was well until a routine left knee replacement three years ago resulted in severe of swelling of her entire left leg. Ultrasound ruled out DVT but identified a previously undiagnosed pelvic A-V malformation with unusual abdominal and pelvic varicosities. This was eventually diagnosed as Klippel-Trenaunay-Weber Syndrome, a rare congenital anomaly, characterized by varicosities and venous malformations of one or more limbs, port-wine stains (capillary malformations), soft tissue and bone hypertrophy. 1 Surgical disruption of this unusual vasculature significantly delayed post-operative recovery due to subsequent lymphatic and venous stasis. Some healthcare providers blamed the patient for failure to improve as expected with treatment prior to her referral to our wound clinic. JA's own tenacity and ingenuity, the support and expertise from our chronic wound care team, development of a "personalized" compression system, and ongoing treatment by a therapist trained in manual lymph drainage 2 combined to produce a unique patient-centered approach to care. Although JA has not been able to return to her job as a community nurse, she is effectively managing the edema with a good understanding of her condition, a positive attitude to self treatment, and a high level of motivation 3. Successful leg edema control not only requires a precise diagnosis and appropriate treatment but patient advocacy and empowerment. The details of JA's experience are presented so that others may learn from this unusual case. |
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