Definition
- Oedema is the clinical manifestation of an accumulation of fluid within the interstital spaces of body
- In most cases it develops when the balance between the flow of fluid out of capillaries and the return of fluid to the vascular space via capillary reabsorption and lymphatic flow is disrupted
- In rare cases oedema is produced by an excess soft tissue
Aetiology
Leg oedema is produced by a multitude of aetiologic factors and the reason behind leg oedema should always be determined. Read more in Table 6 in EWMA document: Lower Leg Ulcer Diagnosis and Principles of Treatment.
Most common local conditions producing leg oedema:
- Venous insufficiency
- Lymphoedema
- Phlebolymphoedema (secondary accumulation of lymph fluids due to venous insufficiency)
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EWMA document: Lower Leg Ulcer Diagnosis and Principles of Treatment
- Red swollen legs are not always erysipelas/cellulitis.
- Infection is seldom bilateral.
The image on the right demonstrates red swollen legs due to phlebolymphoedema, lipodermatosclerosis and stasis eczema. Treatment consisted of II class corticosteroid cream and inelastic compression bandages.
Examination
Clinical examination
- Observation and palpation of the limbs and pedal pulses
- Measuring circumferences of the calves and ankles
- Stemmer`s sign (Pinch a fold of skin at the base of the second toe or finger. If the skin can be lifted, the result is likely to be negative. If the skin can`t be pinched, the result is likely positive. Positive result is a clinical sign of lymphoedema.
Laboratory/imaging investigations
In addition to the laboratory tests in the table:
- Dupplex ultrasound
- Magnetic resonance lymphology (MRL)
Table 8 from EWMA document: Lower Leg Ulcer Diagnosis and Principles of Treatment
Summary of treatments
- Compression therapy
- Intermittent pneumatic compression
- Aquatic therapy
- Surgical therapy (e.g. Liposuction, skin/subcutaneous excision, lymphovenous anastomosis, vascularised lymph node transfer)
