Abdominal apron garment – a cost effective solution for patient to self-manage.
With obesity increasing in the UK (NHS 2016) there is an associated increase in the risk of lymphoedema developing and more complex abdominal management may be required. Even following successful and stable weight loss excess skin still remains. Current funding in the NHS for abdominoplasty to remove the excess skin is a complicated process and is often refused citing it as cosmetic (Fraccalvieri et al 2007).
Finding a solution to maintain the oedema to prevent the risk of infection, skin breakdown and lymphoedema changes, can prove both problematic and complex.
The impact on the patient can be significant including both psychologically and emotionally, including concerns about body image, altered gait, difficultly in mobilising and maintaining balance all can have a devastating effect to the patient’s quality of life (Stuerz 2013).
This poster presents the start of a journey to identify a suitable garment for patients that can provide compression and comfort to maintain the lymphoedema, improve patient confidence to promote independence and self management of the condition.
Patient Y, a 50 year old female, known to the lymphoedema service since 2012 with ISL late stage II lymphoedema changes, presented with bilateral leg and abdominal apron lymphoedema secondary to obesity with a dependent abdominal apron.
The apron was pendulous with multiple breaks in the skin resulting in leaking heavy lymphorrhea and skin changes including papillomatosis, peau d’orange and erythema (LF 2006). This impacted on mobility and quality of life with recurrent episodes of cellulitis and hospital admissions.
Following successfully bariatric surgery in February 2015, patient Y lost weight.
This impacted positively on healing the skin erosions, however the pendulous apron continued to impact physically and psychologically. Surgical intervention for a abdominoplasty has been refused on three separate occasions citing the procedure was cosmetic. With the abdomen apron being so extensive, mobilising proved challenging caused by the pendulum swaying, this in turn altered the gait and increase pain through carrying the heavy weight of the apron. Treatment
Before the bariatric surgery the apron was leaking lymphorrhea. This was initially managed by a specialist lymphoedema service and subsequently in the community by nurses.
Management was achieved by applying compression bandages. Once the apron had healed post bariatric surgery, the community nurses withdrew from applying the bandages.
Since 2016 several garments have been trialled including compression shorts and support garments to maintain the lymphoedema (Elwell 2013). The special purpose oedema garment was the first to achieve comfort and support for Patient Y and available on prescription.
Holding the apron in position and limiting the swaying of the apron improves gait, mobility, pain thereby moving in a positive approach to self management. The design of the garment is based on modified maternity-fit tights.
Finding a solution for patients to self-manage and maintain the lymphoedema is essential to prevent the risk of skin breakdown which in turn increases the risk of infection. Bandaging the abdomen can be expensive and relies on training community nurses who will withdraw services once leaking has stopped.
Previous garments tried by Patient Y did not provide adequate lift, compression, comfort or prevent the swaying of the apron when mobilising. There were also cost implications as not all were available on prescription.
Working in partnership with Juzo UK Ltd we developed a cost effective garment that provides compression to the pendulum apron promoting self management. This special purpose oedema garment requires dexterity to apply and may prove challenging for other obese patient’s who have not successfully lost weight.
The patient’s perspective of the garments is an integral part of the design and further development of this garment will continue in the future.
Development of an alternative garment for those with lymphoedema changes on the abdominal apron and who are unable to apply this garment due to dexterity is being explored.