Management of Lymphatic Weeping Wounds
For lymphatic weeping wounds, the recommended topical wound care approach includes gentle cleansing with warmed sterile water or saline, application of absorbent dressings to collect exudate, and use of nonadherent dressings to protect the wound bed. 1
Initial Assessment and Management
- Evaluate the wound for signs of infection, including increased pain, erythema, warmth, and purulent discharge, as lymphatic wounds are at higher risk for infection due to compromised immune function 2
- Take swabs for bacterial and candidal culture from sloughy or crusted areas to guide antimicrobial therapy if infection is suspected 1
- Administer systemic antibiotics only if there are clinical signs of infection, not prophylactically 1
Wound Cleansing and Preparation
- Gently cleanse wounds by irrigating with warmed sterile water, saline, or dilute chlorhexidine (1/5000) to remove debris while minimizing trauma to the wound bed 1
- Avoid traditional antiseptics like hydrogen peroxide, povidone-iodine, or Dakin's solution as they can be more tissue toxic than commonly recognized 3, 4
- Decompress any blisters by piercing and expressing or aspirating fluid, but leave the detached epidermis in place to act as a biological dressing 1
Dressing Selection for Lymphatic Weeping
- Apply nonadherent dressings directly to the wound bed to prevent trauma during dressing changes (suitable options include Mepitel™ or Telfa™) 1
- Use a secondary foam or specialized burn dressing to collect the often copious exudate from lymphatic weeping (suitable options include Exu-Dry™) 1
- Consider alginates or other highly absorbent dressings for wounds with excessive lymphatic drainage 5
- Change dressings frequently enough to prevent maceration of surrounding skin from prolonged exposure to moisture 2
Topical Treatments
- Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin to the surrounding skin to maintain skin integrity and prevent further breakdown 1
- Consider silver-containing products or dressings for wounds showing signs of critical colonization or local infection, but limit use to small areas due to potential systemic absorption 1
- Apply topical antimicrobial agents only to sloughy areas and based on local microbiological advice, not as routine prophylaxis 1, 6
Advanced Management Considerations
- For wounds with excessive granulation tissue, consider application of silver nitrate to control hypergranulation 5
- Negative pressure wound therapy (NPWT) may be beneficial for wounds with significant lymphatic drainage to help manage exudate and promote formation of granulation tissue 1, 5
- For refractory cases with persistent lymphatic weeping despite conservative measures, surgical interventions such as lymphaticovenular anastomoses may be considered 7
Important Caveats
- Avoid preparations containing sensitizers or irritants that may further damage compromised skin 1
- Regular reassessment is critical - monitor the wound weekly for signs of improvement and change treatment approach if no improvement is seen after 2 weeks 5
- Be vigilant for signs of infection, as lymphatic wounds have compromised immune function and may not present with typical inflammatory signs 2
- Recognize that a monoculture of organisms detected on previously mixed growth cultures may indicate one strain becoming predominant, suggesting increased risk of invasive infection 1