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

Abstract

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.

A Novel Clinical Test for Setting Intermittent Pneumatic Compression Parameters Based on Edema Fluid Hydromechanics in the Lymphedematous Calf

“…1 Long-term observations confirm lasting effects and lack of complications. 2 Efficacy of IPC therapy depends on the applied force (pressure) mobilizing stagnant edema fluid, time of compression to move fluid to the root of the limb, and elasticity of skin and subcutaneous tissue both indurated and hindering transmission of applied force to the deep tissues. These factors should be considered by the therapist before setting the parameters of IPC device adequate for a given patient.…”

Intermittent pneumatic compression in patients with postmastectomy lymphedema

“…Lymphoscintigraphy revealed that pneumatic compression clearly transfers a lot of fluid towards the groin, although the authors also indicate that methods of facilitating the flow of fluid towards tissues that are not swollen and increasing local reabsorption [18] remains unknown. In 18 patients with one-sided edema II-IV (without venous components), pneumatic compression conducted for 24-36 months (45 minutes, pressure: 120 mm Hg, inflation time: 50 seconds for each chamber) influenced a gradual reduction of lower limb circumference and leads to an increase in the flexibility of tissue without any side effects [19].…”

“…surements of limb circumference are used by other researchers [5,9,19,21]. In the studies of Moattari et al, volumetric measurements were performed together with circumference measurements, based on which a high correlation coefficient from 0.80 to 0.92 was obtained for measurements on the olecranon level, then at 10, 15 and 20 cm below and above the olecranon [5].…”

Heating and Compression Bandage Treatment Is Effective for Chronic Lymphedema with Dermatolymphangioadenitis—A Case-Controlled Study

“…2 Olszewski et al 22 note that impaired lymphatic drainage and lack of elimination of penetrating bacteria may be responsible for the progression from uncomplicated lymphedema to that associated with recurrent attacks of DLA. Zaleska et al [23][24][25] confirm that compression of the affected limb can lead to the formation of new tissue channels that can help in reducing the accumulation of lymph fluid. Indeed, Dayes et al have recently shown that SBT alone was as effective as compression bandaging with decongestive massage therapy with regards to percent reduction in arm volume in a study looking at women with arm lymphoedema after breast cancer surgery.…”