Page 42 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire C. Roux
MODERATED POSTER SESSION 3
ANATOMICAL DEFORMATION OF TISSUE IN LYMPHEDEMA - FLUID CHANNEL FORMATION, EFFECT OF INTERMITTENT PNEUMATIC COMPRESSION
ZALESKA M. 1, OLSZEWSKI W. L. 1, KACZMAREK M. 2
1 Central Clinical Hospital, Medical Research Center, Warsaw, Poland 2 Kazimierz Wielki University, Bydgpszcz, Poland
Objectives: We observed formation of tissue channels in advanced obstructive lymphedema increasing in density during high pressure intermittent pneumatic (IPC) therapy.
Methods: Twenty patients with lymphedema stage II/III of lower limbs were investigated. Tissue morphology was evaluated before and after 1 year of intermittent pneumatic compression. Parameters of compression were: inflation pressure 120-100mHg, sequentially from chamber 1 to 8, inflation time of each chamber 50’’, daily for 1 h. Lymphoscintigraphy with Nanocoll was performed before, after 6 and 12 months of treatment. Skin and subcutaneous tissue biopsies were taken before and after treatment. Specimens were injected with Paris Blue in chloroform and made translucent to visualize spaces filled with mobile tissue fluid.
Results: Lymphoscintigraphic imaging. Multiple wide irregular spaces filled with tracer could be seen in the subcutis on the internal aspect of thigh and along large blood vessels running to the groin. There were no such structures around the hip, in hypogastrium and buttocks. Immunohistochemistry of biopsies revealed presence in subcutis and around veins open spaces negative on staining with LYVE1. These spaces were then stained with Paris Blue and presented irregular interconnected spaces. Their density was measured using computer planimetry (Microimage, Olympus). After 1 year of IPC the total area occupied by depicted channels was found slightly increased in calfs but evidently more in thighs.
Conclusions: Increase in stagnant tissue fluid in lymphedematous subcutis is followed by formation of irregular tissue channels. Their density increases after IPC. These channels substitute obliterated lymphatic collectors. Flow in these channels requires active external compression.
THE EFFECTS OF THREE-YEARS PNEUMATIC COMPRESSION OF POSTINFLAMMATORY AND POSTTRAUMATIC EDEMA OF LOWER LIMBS
ZALESKA M., OLSZEWSKI W. L.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Background: Chronic edema of lower limbs after trauma, venous ulcers and recurrent dermatitis is a serious disabling complication affecting millions around the world. The cause of edema are chronic inflammation and venous and lymph stasis. The only solution for therapy of these large cohorts of patients is mechanization of treatment using mechanical devices for intermittent pneumatic compression (IPC).
Aim: To investigate how effective is a 3 years continuous daily high pressure, long inflation time IPC therapy in decreasing limb circumference/volume, tissue elasticity, histological changes and incidental complications.
Methods: Twenty randomly selected patients with unilateral lower limb post inflammatory and posttraumatic edema stage II to IV were treated daily for a period of 3 years with a pneumatic device, 8 chamber sleeve, sequential inflation of chambers to
100-120 mmHg for 50 sec (total 400sec) and no distal deflation, and 50 sec sleeve deflation time. The changes in limb circumference and tissue tonicity were measured at monthly intervals.
Results: Treatment revealed durable decrease of limb circumference and increased elasticity. Improvement was most expressed in the calf above the ankle and mid-calf. Limb circumference was decreased or at least stabilized, elasticity of tissue was increased and maintained. No complications as thigh ring or chronic genital edema were observed.
Conclusions: IPC takes over the transport function of stagnant tissue fluid from the insufficient veins and obliterated lymphatics by squeezing edema fluid to regions with normal drainage. Long term, high pressure IPC, long inflation timing therapy can be safely be recommended to patients with lower limb edema.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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