A newly designed SIPC device for management of lymphoedema

Intermittent Pneumatic Compression for the Treatment of Lower Limb Lymphedema: A Pilot Trial of Sequencing to Mimic Manual Lymphatic Drainage Versus Traditional Graduated Sequential Compression

Background:

Recent advances in technology have allowed intermittent pneumatic compression (IPC) devices to develop so that their function mimics the process and principles of manual lymphatic drainage (MLD); however, research into the effectiveness of such devices is lacking. This study aimed to investigate the effectiveness of a patented IPC technique designed to mimic MLD (the LymphAssist), compared with a typical sequential IPC regimen.

Methods and Results:

Forty patients with a confirmed diagnosis of lower limb ISL (International Society of Lymphology) stage II or III lymphedema were recruited into this three-phased study. A bilateral leg volume assessment and quality-of-life assessment were completed at four clinic visits across the course of the study. The LymphAssist IPC regimen was significantly more effective in reducing distal leg volume than the sequential mode (mean volume reduction: 230 ± 135 mL vs. 140 ± 84 mL, respectively, p = 0.01). Improvements in leg volume were transient as both groups demonstrated a rebound or increase in volume during the washout period (LymphAssist: 238 ± 168 mL, sequential: 276 ± 158 mL, p = 0.3). Overall, IPC was effective in improving quality-of-life scores (mean reduction: 10 ± 11, p < 0.001).

Conclusion:

IPC is effective in reducing limb volume and improving quality of life for patients with lower limb lymphedema. IPC that mimics the MLD process has been shown to be more effective in reducing leg volume compared with traditional sequential IPC in the distal aspect of the leg. The increase in leg volume observed after discontinuation of IPC suggests that regular treatment is required to maintain its associated effects.

Clinical Trial Registration Number: NTC 03856281.

Comparison of efficacy of the intermittent pneumatic compression with a high- and low-pressure application in reducing the lower limbs phlebolymphedema

Introduction

The primary lymphedema and chronic venous insufficiency present an important medical problem, and effective physical therapeutic methods to treat this problem are still at the search phase. The aim of this study was to compare the efficacy of intermittent pneumatic compression (IPC) of a high- or low-pressure level in the treatment of primary phlebolymphedema of the lower limbs.

Methods

The study included 81 patients with chronic venous insufficiency and primary lymphedema of the lower limbs. Group A consisted of 28 patients who underwent a monthly antiedematous therapy including a manual lymphatic drainage, multilayer bandaging, and IPC with the output pressure of 120 mmHg. Group B consisted of 27 patients who underwent the same basic treatment as group A and IPC with the output pressure of 60 mmHg. Group C (control) consisted of 26 patients who underwent only a basic treatment – without IPC.

Results

After completion of the study, it was found that the greatest reduction of edema occurred in patients who underwent treatment with a pressure of 120 mmHg. The comparison of percentage reduction of edema showed a statistically significant advantage of the group A over groups B and C, both for the changes in the right (P=0.01) and the left limb (P=0.01). Results in patients undergoing intermittent compression of the lower pressure (60 mmHg) were similar to those obtained in the control group.

Conclusion

The IPC with the pressure of 120 mmHg inside the chambers effectively helps to reduce a phlebolymphedema. Furthermore, it appears that the treatments with a pressure of 60 mmHg are ineffective and their application becomes useless only in the antiedematous therapy.

Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

Background

Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery.

Methods

We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume.

Results

In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58).

Conclusions

The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.