In this interview, WoundCon speaker Brandy Mckeown shares her insights on new innovations and practical knowledge regarding the treatment of lymphedema and lipedema.

Transcript

1. What inspired you to create and present this session?

I have been a occupational therapist certified in lymphedema treatment for almost 22 years. And so in that process of being a therapist and building clinics and seeing all of these amazing lymphedema patients, we have also run into a large population of lipedema patients in our office. And I think that one of the biggest problems that we have is that practitioners in general have a really difficult time determining between what is a lymphedema patient and what is a lipedema patient? What does that lymphedema patient look like? What are those stages? What does that lipedema patient look like, and what are those stages? Just trying to help others try to navigate through that process of determining which of those patients that is, or maybe it's a mixed disease and we need to know a little bit more about that as well. Definitely the love of the disease process and being able to help other individuals and then practitioners as well.

2. What do you feel are the leading innovations in the field regarding lymphedema and lipedema treatments?

Over the last few years, in the lymphedema world, we had a huge change with what we thought was the processes for the reabsorption of fluid in the tissues of the body. And so we say that it's now a Starlings Revision, which is the endothelial glycocalyx layer. And we've learned so much about this amazing layer of the body and how that layer does not reabsorb any of the fluid back into the veins to be able to reabsorb that fluid. The lymphatic system does all of that now. With that, and then Dr. Hiroo Suami also made a new complete lymphosomal map. He started all of that research back in 2015-16. Started publishing more about that in 2018-2019. And so that lymphosomal map, along with the endothelial glycocalyx layer has led to some wonderful innovations in the world of manual lymphatic drainage and where do we drain this fluid to as lymphoedema therapists. That process has been quite amazing. And then we've got ICG fluoroscopy that is also in development, primarily in the European countries, however we're starting to see more and more of it in the US as well, where we can actually see where that fluid is moving.

And so, us, as practitioners, it would be fabulous if we could actually see that fluid moving and help with diagnosis processes for lymphedema and lipedema patients, really. In the lipedema world, we are seeing more and more research based off of inflammatory processes, so inflammation. Lipedema patients typically are extremely painful, very lumpy adipose tissue, limits mobility, limits function. And what we're finding is that the inflammatory processes with that have a lot to do with it. How do we help with those inflammatory processes as well? And then definitely a lot of those patients also have what we call a lymphedema overload, or they have a lipo-lymphedema, which is where they've got mixed disease, so they have a lipedema, but then ended up with some lymphedema as well. There again, that ICG fluoroscopy would be amazing in order to be able to visualize that fluid moving through those tissues on that lipedema patient as well as that lymphedema patient. We're hoping to see much, much more of those processes in the US in the next few years. It's very exciting work, and I love the fact that we're on this groundbreaking adventure with these new techniques.

3. What do you think is the future of lymphedema and lipedema management strategies?

I definitely think that our techniques are going to be improved as lymphedema therapist. As practitioners that are treating lymphedema patients, treating lipedema patients, I think that all of that is going to be improved by ICG fluoroscopy. There's also new ultrasound techniques that are coming out that are going to help us to be able to visualize the fluid in those tissues. I see all of those techniques just magnifying what we do in the clinics to be able to route this fluid and manage this fluid. I think that we're going to be able to utilize better compression garments based off of these devices as well, and being able to use that research and that mapping with those devices to be able to create the best plans for the drainage for these patients.

The other thing is that there's wonderful new surgical techniques that have been out over the last several years, but they're definitely getting better and better and better so we're still seeing some of the lymphovenous anastomosis with these lymphedema patients and vascularized lymph node transfers. With these lipedema patients we're seeing some amazing liposuction techniques, some water assisted liposuction that is really able to pull out a lot of those tissues that are so incredibly painful for those patients.

We're seeing those techniques as well get more and more research with those techniques, and then those techniques continue to improve and improve and improve over the years for the betterment of these patients. And a lot of these with more severe disease, obviously when we start to talk about the surgical techniques, but we're also starting to see some surgical techniques that are meant for those patients that we know they're at risk and we know that maybe they have a little bit of the beginning of lymphedema, but maybe we can do some surgical techniques to make sure that it never exacerbates to a point where they would ever need full lymphoedema treatment, or even to the point of needing full-time compression garments or anything along those lines. Very exciting work out as well with that. I've seen a piece out by Dr. Wei Chen, who has done some amazing work with those patients in those early out type protocols. Really neat with those as well.

4. What one thing do you think wound care clinicians can apply to their practice to manage these disorders?

I think, first of all, is being able to clinically say, okay, this patient, that's lymphedema, this is lipedema. Lipedema is maybe not as much going to have an effect on our wound healing processes, but very possibly could as well, because we have inflammatory processes that happen with these lipedema patients, we have a likelihood of developing the lipo-lymphedema, which means we have the lymphedema as well, which we know definitely slows down the healing process when we don't have that fluid management control as well as our wonderful wound management. What we really have to figure out is if a patient does have lymphedema, then we've got to be able to control that.

Knowing what it looks like, knowing what the stages of it are, knowing what the presentations are for that lymphedema is going to be able to help us better as wound care clinicians to be able to know when we need even more compression, when we need some manual lymphatic drainage. We need all of those things in order to get a wound to even remotely start to heal. Because what we know about the lymphatic system is that not only does it take 100% of the fluid out of your body, but it's a huge component in that healing process. That's what sends all those antibodies down to heal things. I always say the lymph nodes are like those little garbage cans, but they got some sensors in there, too. It tells the body when our body needs antibodies in a certain area. When the lymphatic system isn't moving, not only do we not have good return of the fluid out of the interstitium, so out of the tissues, however, we also have a significant delay with the body's immune response to those wounds.

As soon as we can the lymphatic system to start flowing more properly and to start really absorbing that fluid back into the lymphatic system, the lymphatic system then can tell the body, hey, we need some antibodies down here to heal things. Then the healing process for those wounds, no matter how wonderful your techniques are with wound management and how wonderful your products are for exudate management and anything else associated with that wound, until we get the edema under control that is surrounding that wound, still going to be a rough road to trying to get that healed and a very slow process.

5. Ultimately, what do you hope readers/clinicians will take away from this session?

I hope, out of everything that they can take away from this session is that they'll have a better idea of what lymphedema looks like, what lipedema looks like, what the difference between the two of them is, and then knowing that there's also that combined disease that we see with those patients. I think if they can identify those patients, then they're going to be able to identify that maybe we're going to have to add a little bit of something to this treatment in order to get this wound to heal.

About the Speaker

Brandy Mckeown is a occupational therapists with 20+years of hands on experience as a lymphedema practitioner. She is director of multiple outpatient clinics in South Georgia that specialize in lymphedema therapy and wound healing. Brandy is also the CEO of International Lymphedema and Wound Training Institute. She is nationally recognized as an expert in the field of lymphedema, leader and board member of several industry organizations, and regularly requested to speak at regional and national conventions. In addition to treating patients, she has a wealth of knowledge and track record building successful lymphedema clinics and works to consult OT/PTs and vein/wound clinics to start up lymphedema programs and expand their practices profitably.