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Talk: Understanding poor Lymphatic function and how to imp... (42 min)

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X Navigable Slide Index
  1. Introduction
  2. Lymphoedema and oedema - key differences
  3. Importance of understanding the lymphatic system
  4. Blood-tissue-lymph systems and their interfaces
  5. Lymphatics is a sewerage system
  6. Importance of the lymphatic system
  7. Organization of superficial lymph system
  8. Functioning of the lymphatic system
  9. Lymphangions visualization
  10. Initial lymphatics
  11. Key practical points - lymphatics
  12. Detailed functioning of the lymphatic system
  13. Lymph nodes
  14. Key practical point - lymph nodes
  15. Big picture overview
  16. Lymph as an environment
  17. Key practical point - lymph environment
  18. Deep and superficial systems
  19. The deep lymphatic system in torso
  20. Key practical point - deep/superficial systems
  21. The adipo-lymphatic connection
  22. Fats in the diet & lymph load and flow
  23. Lymphatic drainage from the small intestine
  24. Chylous reflux into limbs, urinary and genital areas
  25. Key practical point - diet and the lymphatics
  26. Factors which determine lymph load
  27. Factors which determine lymph flow
  28. Development of lymphoedema
  29. Types of lymphoedemas
  30. Primary lymphoedema
  31. Genetics of primary lymphoedema
  32. Secondary lymphoedema
  33. Pre-disposition to lymphoedema
  34. The three stages of lymphoedema
  35. Lymphoedema - one developmental view
  36. Each territory may be affected differently
  37. Fatty epi-fascial tissue accumulation
  38. Subcutaneous fat and lymph transport
  39. Lymphoedema is more than just a swelling!
  40. Skin changes in lymoedema
  41. Buildup of fibrous tissues consequences
  42. The problems of fibrosis
  43. Key practical point - fibrous build up
  44. Proximity issues
  45. Proximity issues - lymph and vascular systems
  46. Lymphatics in adventitial areas of veins
  47. Proximity issues - diseases and disorders
  48. Key practical point - proximity issues
  49. Conditions which look like lymphoedema
  50. Lipoedemas
  51. Development of lipoedema
  52. Basic pathology
  53. Myxoedema
  54. Phlebo-lymphoedema
  55. Development phlebo-lymphoedema
  56. Key practical point - look alike conditions
  57. Back to lymphoedema
  58. Adipose tissue, fibrosis and lymphoedema
  59. Key practical point - adipose tissues & fibrosis
  60. Remember the differences?
  61. What should we do to improve tissue/cell health?
  62. END
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DETAILED SLIDE INDEX

  1. 1. Introduction
  2. 2. Lymphoedema and oedema - key differences
  3. 3. Importance of understanding the lymphatic system
  4. 4. Blood-tissue-lymph systems and their interfaces
  5. 5. Lymphatics is a sewerage system
  6. 6. Importance of the lymphatic system
  7. 7. Organization of superficial lymph system
  8. 8. Functioning of the lymphatic system
  9. 9. Lymphangions visualization
  10. 10. Initial lymphatics
  11. 11. Key practical points - lymphatics
  12. 12. Detailed functioning of the lymphatic system
  13. 13. Lymph nodes
  14. 14. Key practical point - lymph nodes
  15. 15. Big picture overview
  16. 16. Lymph as an environment
  17. 17. Key practical point - lymph environment
  18. 18. Deep and superficial systems
  19. 19. The deep lymphatic system in torso
  20. 20. Key practical point - deep/superficial systems
  21. 21. The adipo-lymphatic connection
  22. 22. Fats in the diet & lymph load and flow
  23. 23. Lymphatic drainage from the small intestine
  24. 24. Chylous reflux into limbs, urinary and genital areas
  25. 25. Key practical point - diet and the lymphatics
  26. 26. Factors which determine lymph load
  27. 27. Factors which determine lymph flow
  28. 28. Development of lymphoedema
  29. 29. Types of lymphoedemas
  30. 30. Primary lymphoedema
  31. 31. Genetics of primary lymphoedema
  32. 32. Secondary lymphoedema
  33. 33. Pre-disposition to lymphoedema
  34. 34. The three stages of lymphoedema
  35. 35. Lymphoedema - one developmental view
  36. 36. Each territory may be affected differently
  37. 37. Fatty epi-fascial tissue accumulation
  38. 38. Subcutaneous fat and lymph transport
  39. 39. Lymphoedema is more than just a swelling!
  40. 40. Skin changes in lymoedema
  41. 41. Buildup of fibrous tissues consequences
  42. 42. The problems of fibrosis
  43. 43. Key practical point - fibrous build up
  44. 44. Proximity issues
  45. 45. Proximity issues - lymph and vascular systems
  46. 46. Lymphatics in adventitial areas of veins
  47. 47. Proximity issues - diseases and disorders
  48. 48. Key practical point - proximity issues
  49. 49. Conditions which look like lymphoedema
  50. 50. Lipoedemas
  51. 51. Development of lipoedema
  52. 52. Basic pathology
  53. 53. Myxoedema
  54. 54. Phlebo-lymphoedema
  55. 55. Development phlebo-lymphoedema
  56. 56. Key practical point - look alike conditions
  57. 57. Back to lymphoedema
  58. 58. Adipose tissue, fibrosis and lymphoedema
  59. 59. Key practical point - adipose tissues & fibrosis
  60. 60. Remember the differences?
  61. 61. What should we do to improve tissue/cell health?
  62. 62. END

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USE THIS TALK IN YOUR COURSE

TALK'S CITATION

Piller, N. (2014), "Understanding poor Lymphatic function and how to improve it: Revisiting old facts and examining new leads to help wounds heal", in Schultz, G. (ed.), Wound Healing: , The Biomedical & Life Sciences Collection, Henry Stewart Talks Ltd, London (online at http://hstalks.com/?t=BL1863727)

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ABOUT THIS TALK

Speaker(s)

Prof. Neil Piller Show Biography

SPEAKER BIOGRAPHY

Prof. Neil Piller – Flinders University, South Australia

Neil is a Lymphologist and the Director of the Lymphoedema Research Unit in the Department of Surgery, School of Medicine at Flinders University, South Australia. He runs a semester long specialist elective program in the MD called Lymphatics in Health and Disease and is coordinator of Advanced Studies.Neil is a Director of the International Lymphoedema Framework, an executive member of the International Society for Lymphology, Clinical Sciences editor for the “Journal of Lymphoedema” (UK), Australasian Editor or the Journal of Lymphatic research and Biology (USA). and a member of the editorial boards of “Phlebology” (USA) and “Lymphology” (USA) Neil is a member International Advisory Board Union Internationale Phlebologie and a member of its consensus groups on Lymphoedema and phlebo-lymphoedema, and a member of the steering committee for the Australian and American Lymphoedema Frameworks as well as a member of the International Compression Club. In 2013 he was invited guest speaker at the European Lymphology Congress in Valencia, the 24th International Society of Lymphology congress in Rome and the New Zealand Wounds Care Society meeting in Auckland. In 2014 he was guest speaker at the Taiwan Vascular Surgery Association meeting in Taipei, the International Lymphoedema Framework Meeting in Glasgow and the Norway Lymphoedema Foundation meeting in Oslo. In May 2016, Neil will jointly organize (along with the Australasian Lymphology Association and the Australasian Chapter of the International Lymphoedema Framework) a meeting in Darwin Australia focusing on issues of lymphoedema, in hot and humid climates Neil and Maree O’Connor’s “Lymphoedema Handbook” for therapists continues to have a wide impact and Neil’s CD/DVD “The Vital Essence- Understanding Lymphoedema in health and disease” continues to help in the informing of patients and practitioners on what can be done to better manage and treat lymph and other oedemas.

Publication Date

October, 2014

Topics Covered

Lymphoedema and oedema: key differences... more

TOPICS COVERED IN THIS TALK

  • Lymphoedema and oedema: key differences
  • Blood-tissue-lymph systems and their interfaces
  • Importance of the lymphatic system
  • Organization of superficial lymph system
  • Functioning of the lymphatic system
  • Consequences of poor lymph flow
  • Deep and superficial systems
  • The adipo-lymphatic connection
  • Fats in the diet: How they affect lymph flow and load
  • Lymphatic drainage from the small intestine
  • Blockage/overload and chylous reflux
  • Factors which determine lymph load and flow
  • Development of lymphoedema
  • Types of lymphoedemas
  • Increased subcutaneous fat reduces lymph transport
  • Build-up of fibrous tissues reduces lymphatic function
  • The problems of fibrosis
  • Proximity issues
  • Other limb swellings which look like lymphoedema which may underlie the wound area: Lipoedemas, Myxoedema and Phlebo-lymphoedema
  • Adipose tissue, fibrosis and lymphoedema
  • What can be done to improve tissue/cell health and improve wound healing?

Series

Wound Healing

OTHER TALKS IN THIS SERIES

VIEW THE TALKS
Play '1. Molecular and cellular regulation of wound healing; what goes wrong when wounds fail to heal or heal too much?'
1. Molecular and cellular regulation of wound healing; what goes wrong when wounds fail to heal or heal too much? More info
Prof. Gregory Schultz

TOPICS COVERED IN THIS TALK

  • Sequence of Molecular and Cellular Events in Skin Wound Healing
  • Hemostasis, Inflammation, Repair and Remodelling
  • Chronic wounds
  • Role of matrix metalloproteinases in wound healing
  • Wound Bed Preparation and ‘T I M E’
  • Pathological Scarring
  • Treatments to reduce scarring
Play '2. Genes in skin wound healing: microRNAs - Part 1 of 2'
2. Genes in skin wound healing: microRNAs - Part 1 of 2 More info
Prof. Chandan K. Sen

TOPICS COVERED IN THIS TALK

  • Types of wounds, intervention and the healing process
  • Molecular oxygen and its role in wound healing
  • Gene expression in wounds
  • MicroRNA: drivers of the wound healing process
  • The involvement of miRNA in redox regulated angiogenic response
  • Micromanaging vascular biology
  • Distribution of oxygen in the wound tissue
  • Altered miRNAs in response to state of tissue oxygenation
  • OxymiRs: oxygen-sensitive miRs influence wound closure
  • Ischemia and hypoxia
  • The reaction to hypoxia: HIF and hypoxamirs
  • The murine ischemic wound model
  • Ischemic wound impaired epithelialization and proliferation
  • The expression of miR-210 and E2F3 in ischemic wounds
Play '3. Genes in skin wound healing: microRNAs - Part 2 of 2'
3. Genes in skin wound healing: microRNAs - Part 2 of 2 More info
Prof. Chandan K. Sen

TOPICS COVERED IN THIS TALK

  • miR-200b: potent angiostatic miRNA
  • Diabetic wounds
  • Wound closure and angiogenesis in diabetic wounds
  • miR-200b expression in diabetic wounds
  • GATA2 & VEGFR2
  • Biofilms: microbial social network
  • Multi-species biofilm infection in a swine burn wound model
  • Biofilm specific genes expressed in bacteria
  • Biofilm impairs tight junction function
  • Silencing of ZO-1 and ZO-2 by biofilms
  • Biofilm induces specific skin miRNA:miR-146a & miR-106b
Play '4. Biofilms and chronic wounds: winning the war in wounds'
4. Biofilms and chronic wounds: winning the war in wounds More info
Prof. Gregory Schultz

TOPICS COVERED IN THIS TALK

  • Sequence of Molecular and Cellular Events in Skin Wound Healing
  • Hypothesis of Chronic Wound Pathophysiology
  • Bacterial Biofilms
  • Damage caused by immune response to biofilms
  • Role of matrix metalloproteinases in wound healing
  • Why are biofilms difficult to kill?
  • Can Dressings Disrupt & Kill Mature Biofilms?
  • Larval Debridement Therapy
  • Negative Pressure Wound Therapy
Play '5. Dynamic reciprocity and wound healing'
5. Dynamic reciprocity and wound healing More info
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TOPICS COVERED IN THIS TALK

  • Influences of the wound micro-environment to either foster and sustain wound healing or impede wound closure
  • Matrix-associated signals govern tissue responses
  • The Dynamic reciprocity paradigm to encompass the ongoing 'crosstalk' between cells and their extracellular milieu in response to injury and during healing
  • Examples of dynamic reciprocity during wound healing
Play '6. Wound bed preparation and TIME'
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TOPICS COVERED IN THIS TALK

  • TIME acronym for managing wound bed preparation 10 years old; needs updating
  • Awareness of evidence based medicine and need for more quality research
  • Guidelines still needed; depend on best available evidence and “expert”consensus
  • 10 year developments considered
  • Tissue developments: new debridement methods, negative pressure therapy (NPT)
  • Infection developments: better understanding of microbiology, biofilms and antiseptics, antimicrobial therapy and new dressings
  • Moisture control: improvements with better dressing management and NPT
  • Edge: accurate monitoring and adjunctive therapies
  • TIME part of holistic care: TIME revisited in International Wound Journal 2012; 9 (supplement)- the focus expanded and still evolving
Play '7. Negative pressure wound therapy: mechanisms of action  and clinical uses'
7. Negative pressure wound therapy: mechanisms of action and clinical uses More info
Prof. Dennis P. Orgill

TOPICS COVERED IN THIS TALK

  • History and Technology Transfer
  • Biology of Stretching Skin
  • Primary Mechanisms of NPWT: Macrodeformation, Microdeformation, Fluid removal, Moist wound environment
  • Secondary Mechanisms: Angiogenesis, Inflammation, MMPs, Peripheral Nerves
  • Case examples: Sternal wounds, Open Abdomen, Groin Wounds, Skin Grafts
Play '8. Deep tissue injury: the state of the science'
8. Deep tissue injury: the state of the science More info
Prof. Joyce Black

TOPICS COVERED IN THIS TALK

  • The history of deep tissue injury (DTI)
  • Description and definition of deep tissue injuries
  • How does a pressure ulcer develop?
  • The roles of shear, hypoxia and ischaemia in DTI
  • Reperfusion injury in DTI
  • Outcomes of DTI
  • Diagnosis
  • Prevention
  • Distinguishing DTI from conditions with similar appearance
  • Treatments
Play '9. Biofilm based wound care'
9. Biofilm based wound care More info
Dr. Randall Wolcott

TOPICS COVERED IN THIS TALK

  • Biofilm in nature
  • Host biofilm development
  • Bacterial biofilm & wound healing
  • Molecular mechanisms of senescence
  • Planktonic vs. biofilm bacteria
  • Medical biofilms
  • Biofilm defences
  • Antibiotic resistance
  • Reconstitution of slough
  • The epithelial gap
  • Full biofilm debridement
  • Acute vs. chronic wound
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  • Surface management
  • Sharp debridement
  • Osteomyelitis
  • Common skin & skin-structure infection (cSSSI) pathogens
  • Clinical identification of bacteria
  • Biofilm-based wound care (BBWC)
  • Multiple concurrent dynamic strategies
  • Personalized wound care
  • Negative-pressure wound therapy (NPWT)
  • Cell-based therapy (CBT)
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