Wound Care - Non Healing Ulcer

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• Swollen patients have lower oxygen delivery to the cells due to Fick’s law of diffusion. The oxygen released in the capillaries has to diffuse a greater distance through the interstitial fluid to get to the cells. This creates additional stress for the cells and increases infection risk.

• Compression helps by increasing hydrostatic pressure and helps force the fluid back in the bloodstream, reducing the edema. This restores oxygen and nutrient delivery to the cells.

• White blood cells require oxygen to fight infections. White blood cells use oxygen to create oxygen radicals that help fight infections. Superoxide Dismutase is the enzyme in the macrophage white blood cells that creates the oxidative burst that fights infection. If the oxygen tension is lower, white blood cells do not function as well, increasing infection risk and severity.

• Bacteria which enter the interstitial fluid planes can travel through the fluid planes and spread quickly. Reducing edema helps reduce infection severity. You can see below how the bacteria quickly travel and replicate in the interstitial space between the cells.

• The fluid found in the interstitial space of lymphedema patients has elevated protein content. These proteins can serve as nutrients for the bacteria to grow and spread more quickly. Also, the body uses Macrophages to process the lymph proteins in the interstitial fluid, which may reduce the body’s ability to fight the infection. This is why infections tend to be worse in lymphedema patients (JOBST)

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