Lymphoedema in patientswith chronic venous ulceration of the lower legs
Journal Title: Dermatologia Kliniczna - Year 2006, Vol 8, Issue 2
Abstract
Venous ulceration of the lower leg occurs in about 1% of the population and represents an important social problem owingto its longduration and high cost of management. Venous ulceration is most often connected with chronic venous insufficiency. Venostasis leads to the development of vascular and dermal lesions, and damage of the endothelial cells results in the formation of the so-called leucocytal trap. In microcirculation cytokines IL-1, IL-6, IL-8 are released. Activation of fibroblasts gives rise to a fibrination process which brings about lymphostasis and oedema. Superficial and deep lymphatic systems are distinguished inthe lower extremity. Lymph filtration takes place in lymph nodes which owing to their phagocytic function constitute a protective barrier against penetration of noxious agents from the tissues to the blood. The lymph is a tissue fluid which unlike the plasma becomes absorbed by suction into the system of lymphatic vessels. Under normal conditions lymphatic vessels show rhythmic contractions occurring 4-6 times per minute with the frequency depending on the degree to which the vessels are filled with the lymph. The development of oedema is conditioned by an increase in the venous pressure, an increase in the hydrostatic pressure in the microcirculation, and by transport efficiency of the lymphatic system. Lymphoscintigraphy performed with the use of human albumin labeled with technet Tc99 is the gold standard in the assessment of lymphoedema. Remarkable lesions may be observed in the ulceration area of the lower legs where the distribution of the isotopic marker is delayed. The skin in the neighbourhood of the ulceration is usually reddened and swollen. The lymphoscintigraphic investigation performed in patients with venous ulceration of the lower legs have shown that in the majority of these patients the passage time of the radiopharmaceutical preparation in the afflicted extremity is 2-3 times longer as compared with that in the normal extremity. This is due to disturbances of the lymphatic drainage caused by ulceration.
Authors and Affiliations
Ryszard Markert, Jerzy Nowacki, Michał Duszewski
Keywords
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