Sequential Pneumatic Compression for Lymphedema

Richmand, D

doi:10.1001/archsurg.1985.01390340014002

Cited by 96 publications

(40 citation statements)

References 3 publications

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“…The results of this investigation support the observation, reported in previous studies, [23][24][25][26][27] that pneumatic compression pumps can be used safely and effectively for the treatment of patients with breast carcinoma-associated lymphedema. Conversely, we were unable to validate published claims that IPC has a deleterious effect on patients who receive prior treatment for lymphedema.…”

Section: Discussionsupporting

confidence: 90%

“…The incorporation of IPC into a multidisciplinary, therapeutic approach long has been advocated empirically by some physiotherapeutic schools. 21,22 Numerous early studies purported to demonstrate the efficacy of pumps as a sole therapeutic intervention for patients with lymphedema; [23][24][25][26][27] nevertheless, individual reports of complications and lack of efficacy 28 -30 have tended to dampen enthusiasm for the use of IPC. It was to address these unresolved questions that the current study was undertaken.…”

Section: Discussionmentioning

confidence: 99%

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Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Szuba

Achalu

Rockson

2002

Cancer

189

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BACKGROUNDDisruption of the lymphatic circulation through breast carcinoma‐associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma‐associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma‐associated lymphedema, prospective study of its adjunctive safety and efficacy is required.METHODSIPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma‐associated lymphedema. Twenty‐three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma‐associated lymphedema also were assessed in the maintenance phase of therapy. Twenty‐seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility.RESULTSDuring initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion.CONCLUSIONSWhen IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications. Cancer 2002;95:2260–7. © 2002 American Cancer Society.DOI 10.1002/cncr.10976

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Szuba

Achalu

Rockson

2002

Cancer

189

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“…Richmand et al showed that more than 80% of patients in both the poor-response and partial-response groups had long-lasting lymphedema with subcutaneous fibrosis. 11 We suggest that the decrease of the mobile tissue fluid volume and pressure prevents secondary tissue changes. Thus, the IPC therapy is aimed not only at evacuation of excess tissue (edema fluid) to decrease limb volume/weight but also, and probably more importantly, at prevention of secondary tissue changes developing mainly in the lower part of the calf as hardening of skin and subcutis, lymph leakage, ulceration, all seen in advanced stages of lymphedema.…”

Section: Fig 10mentioning

confidence: 84%

“…The 5 Well controlled studies have documented its usefulness in the treatment of lower limb lymphedema, thereby supporting their continued use. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, no long-term observations have so far been documented. The difference between our and others' studies relied mainly on that we applied long inflation times and relatively high pressures, based on our previously published tissue fluid pressure/flow data.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Intermittent Pneumatic Compression in Long-Term Therapy of Lymphedema of Lower Limbs

Zaleska

Durlik

2014

Lymphatic Research and Biology

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Background: The manual lymphatic drainage in lymphedema has proved to be successful; however, this method cannot be applied to millions of patients around the world. The only solution is to offer inexpensive, easily accessible mechanical devices for pneumatic compression (IPC). These devices should be designed on parameters of edema fluid hydromechanics. Recent data point to high pressures and long time of compression. Aim: To validate the effects of 3 years daily high pressure, long inflation time IPC therapy in terms of decrease of limb circumference/volume, tissue elasticity, histological changes, and incidental complications. Methods: A group of 18 patients with unilateral leg lymphedema stage II to IV was treated for a period of 3 years using an 8-chamber sleeve, sequential inflation of chambers to 100-120 mmHg for 50 sec (total 400 sec). Limb circumference and tissue tonicity were measured at monthly intervals. Correlation between decrease in calf and thigh circumference and increase in elasticity was done. Results: The treatment revealed durable permanent decrease of limb circumference and increased elasticity of tissues. The improvement was most expressed in the calf above the ankle and mid-calf. No complications as thigh ring or chronic genital edema were observed. There was no direct correlation between the decrease in limb circumference and increase in elasticity, most likely due to different mass of fibrous tissue. Conclusions: IPC takes over the permanently missing function of the obliterated lymphatics by squeezing edema tissue fluid to the regions with normal lymphatic drainage. The limb circumference is decreased or at least does not further increase, elasticity of tissue is increased and maintained. No complications in limb tissues were observed. The long-term, high pressure IPC, long inflation timed therapy can be safely be recommended to patients with lower limb lymphedema.

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“…Several controlled studies already from the 1980-1990s have documented their usefulness in the treatment of this condition, thereby supporting their continued use. [1][2][3][4][5][6][7][8] The new publications further strengthen the efficacy of intermittent pneumatic compression (IPC) in therapy of limb edema. [9][10][11] A recent systemic review from 2004-2011 on the use of IPC, found that the use this method in treating lymphedema is well-founded in the literature.…”

mentioning

confidence: 99%

Pressures and Timing of Intermittent Pneumatic Compression Devices for Efficient Tissue Fluid and Lymph Flow in Limbs with Lymphedema

Zaleska

Jain

et al. 2013

Lymphatic Research and Biology

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Pneumatic compression of tissues with lymph stasis is, aside from the manual massage, a commonly used therapeutic modality in limb lymphedema. A number of pneumatic devices have been constructed. There is lack of reports of comparative studies determining inflation pressure levels, inflation/deflation cycle times, and total pumping times. Aim: We tried to answer the question how high compression pressure and how long compression timing should be applied to the limb soft tissues to reach tissue fluid (TF) head pressure above 30 mmHg, necessary to initiate proximal flow. Methods: TF pressures were measured subcutaneously during intermittent pneumatic compression in the lymphedematous limbs stage II to IV. Pressures of 50, 80, and 120 mmHg and timing 5, 20, and 50 sec were applied. Results: a) the TF head pressures were lower than those in inflated chambers, b) inflation time of 5 and 20 sec was not long enough to generate TF head pressures above 30 mmHg, even if the compression pressures were as high as 120 mmHg, c) the 50 sec timing allowed to reach head pressures above 30 mmHg; however, they remained always lower than in the compression chamber, d) TF head pressures differed at various levels of the limb depending on the soft tissue mass, e) deflation of the inflated whole sleeve for 5 and 20 sec was followed by high end pressures, whereas that of 50 sec brought about pressure drop to 0, facilitating refilling with TF of the distal parts of the massaged limb. Conclusions: Our observations point to the necessity of applying high pressures and compression times over 50 sec, to generate effective TF pressures and provide enough time for creating TF flow. Short inflation times generate TF pressures as in one-chamber devices that preclude its effectiveness compared to the multi-chamber devices.

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Sequential Pneumatic Compression for Lymphedema

Cited by 96 publications

References 3 publications

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

The Effectiveness of Intermittent Pneumatic Compression in Long-Term Therapy of Lymphedema of Lower Limbs

Pressures and Timing of Intermittent Pneumatic Compression Devices for Efficient Tissue Fluid and Lymph Flow in Limbs with Lymphedema

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