Hettrick Heather, Aviles Frank
Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida.
Natchitoches Regional Medical Center, Natchitoches, Louisiana.
Wound Manag Prev. 2022 Jan;68(1):8-15.
Chronic edema affects millions of people in the United States and worldwide. Edema can result from a variety of diseases, trauma, medications, and other contributing factors; however, all edema is related to lymphatic fluid dysregulation. Additionally, lymphatic impairment and integumentary dysfunction are interrelated, leading to complex clinical presentations that require an integrated medical model of care to maximize outcomes.
This narrative review article will highlight the current evidence that details lymphatic physiology, fluid regulation by the endothelial glycocalyx layer, and the interconnectedness of the vascular and integumentary systems leading to a paradigm shift in our understanding of edema, lymphedema, and chronic wounds. Traditional pedagogy remains siloed with respect to the body systems, whereas current evidence indicates a certain interdependence, particularly between and among the venous, lymphatic, and integumentary systems.
Comprehensive narrative review of the current and past literature (2010-2021 through PubMed, Google Scholar, MEDLINE Complete, UpToDate) focusing on lymphatic physiology, fluid regulation, the endothelial glycocalyx layer, lymphedema, and venous insufficiency. Review focuses on new evidence supporting the interconnectedness of the systems to support a unified medical management approach.
All edema is related to lymphatic dysfunction, whether transient or permanent, thereby creating a lymphedema continuum. Further, lymphatic impairment creates cutaneous regions of skin barrier failure, rendering the skin more susceptible to breakdown and chronic wounds.
A synthesis of the current evidence suggests an interconnected relationship of the lymphatic, venous, and integumentary systems, highlighting the need for a more integrated medical model of care to provide efficient and comprehensive care and improve patient outcomes.
在美国及全球，慢性水肿影响着数百万人。水肿可由多种疾病、创伤、药物及其他因素引起；然而，所有水肿都与淋巴液调节异常有关。此外，淋巴功能障碍与皮肤功能障碍相互关联，导致临床表现复杂，需要综合医疗模式来实现最佳治疗效果。
这篇叙述性综述文章将重点介绍当前的证据，这些证据详细阐述了淋巴生理学、内皮糖萼层对液体的调节以及血管和皮肤系统的相互联系，从而使我们对水肿、淋巴水肿和慢性伤口的理解发生范式转变。传统教学在身体系统方面仍各自为政，而当前证据表明存在一定的相互依存关系，尤其是在静脉、淋巴和皮肤系统之间。
对当前和过去的文献（2010 - 2021年，通过PubMed、谷歌学术、MEDLINE Complete、UpToDate）进行全面的叙述性综述，重点关注淋巴生理学、液体调节、内皮糖萼层、淋巴水肿和静脉功能不全。综述聚焦于支持系统相互联系以支持统一医疗管理方法的新证据。
所有水肿都与淋巴功能障碍有关，无论其是短暂性还是永久性的，从而形成一个淋巴水肿连续体。此外，淋巴功能障碍会导致皮肤屏障功能失效的区域，使皮肤更容易发生破损和慢性伤口。
综合当前证据表明，淋巴系统、静脉系统和皮肤系统之间存在相互联系，这凸显了需要一种更综合的医疗模式来提供高效、全面的护理并改善患者治疗效果。
