Leg Tissue Edema Hampers Healing- modern Methods for Detection of Fluid Location and Concentration,

Background: Edema of tissues accompanies leg cellulitis, ulcers, venous and lymphatic stasis. Although it is a positive inherent component of inflammation, intercellular fluid excess may lead to damage of tissue structure as epidermal desquamation, infection, ulcers, and subsequent fibrosis. Moreover, mechanical wounds’ healing is impaired.

Aim: To prove the efficacy of modern tissue edema fluid detection methods and hints for effective fluid evacuation.

Methods: The following methods were applied in 100 legs with lymphedema, cellulitis and non-healing ulcers: dielectric constans- subepidermal water, bioimpedance-electric conductivity depending on extracellular water contact, durometry - skin stiffness, deep tonometry- subcutaneous tissue stiffness, fluid mobilization force meter, visualization by indocyanine green fluorescence, lymphoscintigraphy, tissue spaces Xray graphy, ultrasonography (US) and MRI. All these methods provide data on edema fluid volume necessary for evaluation of compression procedures.

Results: Edema parameters were similar in all listed pathologies either in the entire limb or inflamed fragments. Subepidermal water > 40%, bioimpedance Ldex >10, skin stiffness > 0.8 Newtons, deep tonometry > 1kg/sq.cm, fluid mobilization > 50mmHg, ICG fluorescence level- 40-60%, lymphoscintigraphy- subdermal accumulation, US- fluid “lakes” and MRI honey-comb image. Images will be presented.

Conclusions: Compression therapy to decrease edema and inflammation and facilitate healing of ulcers should be applied basing on edema fluid physical parameters.