Endothelial glycocalyx layer and interdependence of lymphatic and integumentary systems

The endothelial glycocalyx layer controls movement of proteins and fluid across the blood capillary wall and there is no reabsorption back into the venous side of blood capillaries. Reabsorption occurs through lymphatic capillaries alone; consequently, a new paradigm of all oedemas falling into a continuum of relative lymphatic dysfunction is embraced. Additionally, areas of lymphatic failure produce areas of integumentary vulnerability subject to infection, inflammation and carcinogenesis; essentially, skin barrier failure. These combined findings highlight interdependence of the lymphatic and integumentary systems and the need for a more unified clinical approach.


  • Robyn Bjork

    Founder, CEO, International Lymphedema & Wound Training Institute (ILWTI)

  • Heather Hettrick

    Associate Professor, Department of Physical Therapy, Nova Southeastern University