Oedema and ulcer and wound healing

Oedema requires accurate diagnosis and management because it can be detrimental to wound healing. Patients with oedema have excess fluid and protein in the interstitial space, potentially leading to increased risk of infection, reduced circulation, inflammation, inhibition of growth factors, lymphorrhoea (leakage of lymph fluid) and maceration.

Oedema may be caused or worsened by heart failure, renal or liver impairment, limb dependency (having legs down or dangling; eg in patients with limited mobility), venous insufficiency, protein deficiency, lymphoedema or acute trauma.

Oedema may be drug induced; always take a thorough medication history. Common drug causes of oedema include:

• calcium channel blockers (particularly dihydropyridines, eg amlodipine)
• alpha₂ agonists (eg clonidine)
• corticosteroids
• sex hormones (eg estrogen, progesterone, tamoxifen)
• chemotherapy drugs
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• glitazones (eg pioglitazone)
• pramipexole
• pregabalin.

If a drug cause is likely, consider if the drug can be stopped or the dose modified to improve or resolve oedema.

Reducing oedema improves wound healing. Management is specific to the cause of oedema and may include compression, elevation of the limb, movement, manual lymphatic drainage, medication alteration and complete decongestive therapy. Some of these approaches reduce fluid loss into the interstitium (eg compression therapy) as well as increasing lymphatic reabsorption.