Original communication Effectiveness of manual lymphatic drainage and intermittent pneumatic compression in lymphedema maintenance therapy Erika Mendoza1 and Felix Amsler2 1 Venenpraxis Wunstorf, Germany 2 Amsler Consulting, Basel, Switzerland Summary: Background: To compare the effectiveness of intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance treatment of lymphedema. Patients and methods: Patients in the maintenance phase of lymphedema therapy with MLD and compression since more than a year with stable values for weight and circumferences of ankle and calf were asked to participate in a study: Compression had to be worn daily, (1) 4 weeks IPC+MLD, (2) 4 weeks MLD alone, (3) 4 Weeks IPC alone (Order 1 and 3 was randomized). At the beginning and after each 4 weeks, circumference measurements (by hand and by machine: BT600., Bauerfeind) were documented, pain and discomfort were assessed, and quality-of-life questionnaires were completed. Results: Of 20 participants, 18 (14 female, 4 male), mean age 59.6 years (48–89) could be evaluated. 11 subjects had bilateral, 7 unilateral, 5 primary, 13 secondary lymphedema since 2–20 years (mean 7.7), the subjects had received MLD and compression for 2–14 years (mean 6.4), 1–3 times per week (mean 1.5). The BMI ranged between 21 and 47 (mean 33.7). No differences between any phases were found for: Calf and thigh volume, circumference of calf. Only the ankle circumference was significant less (.0.22 cm) when using “both” (IPC+MLD). Compared to before the study, quality of life was better in all three phases, but with a significantly higher improvement in the phases with IPC than in the phases without. Conclusions: There were no differences in objective measurement between MLD alone, IPC alone or both, excepting the minimal significant difference in ankle circumference after IPC+MLD. QOL favored IPC application. Considering the economic consequences of these results, a change of maintenance therapy with MLD weekly over years in favor of permanent care with IPC and few appointments of MLD per year should be considered and further investigated. Keywords: Lymphedema, manual lymphatic drainage, intermittent pneumatic compression, lymphedema social costs, lymphedema maintenance therapy Introduction Lymphedema is a condition caused by a delay in lymphatic drainage: it can be congenital, induced by damage to the lymphatic channels (surgery, trauma, radiation) or occur due to compression of the lymphatic channels (tumors compressing them or obesity-related lymphedema). Typi- cally, the toes and the dorsum of the foot show early changes with so-called “box toes” and transverse folds at the base of the toes. The edema has a rather doughy consis- tency. It is divided into three stages (stage I, reversible overnight; stage II, protein deposits, not reversible over- night; stage III, fibrosis and skin discoloration up to ulcera- tion) [1]. The therapy of lymphedema in stage II and III consists in a first phase of complex physical decongestive therapy (CPD), combining compression (first bandaging, then stockings), added by manual lymphatic drainage (MLD) and/or intermittent pneumatic compression (IPC) depending on the findings and patient education with exer- cise, skin care and nutrition [1, 2]. This phase of initial decongestion is followed by the so- called “maintenance therapy” as long as the lymphedema is present. In this phase, compression alone or a combina- tion with MLD, IPC or both are possible, according to the German guideline [1]. The current treatment reality shows, that compression and MLD are mainly used, IPC seldom and specially in addition when MLD and compression stockings cannot keep the decongestion level in the main- tenance therapy. IPC is preferably performed with a device composed by a compressor unit and two boots with 12 overlapping cham- bers, inflating and deflating regularly from toes to thigh and back. The patient can perform self-management at home, using the device as often as he wishes. IPC products . 2023 The Author(s) Distributed as a Hogrefe OpenMind article Vasa (2023), 52 (6), 423–431 under the license CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) https://doi.org/10.1024/0301-1526/a001090 423 https://econtent.hogrefe.com/doi/pdf/10.1024/0301-1526/a001090 - Wednesday, November 29, 2023 2:49:54 AM - IP Address:93.208.161.46
