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A NOVEL CLINICAL TEST FOR SETTING INTERMITTENT PNEUMATIC COMPRESSION PARAMETERS BASED ON EDEMA FLUID HYDROMECHANICS IN THE LYMPHEDEMATOUS CALF
OLSZEWSKI W. L., ZALESKA M.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Introduction: Increasing number of patients with lymphedema of limbs requires development of new simple methods with easy access. To obtain satisfactory results knowledge of hydromechanic events under the applied hand or device became necessary. The Linforoll device is the first ever construction for manual edema fluid drainage allowing standardization of applied force depending on local anatomy of soft tissues and their tonicity, timing of applied force, unidirectional fluid movement, detecting sites of increased tissue hydraulic resistance and painful inflammatory foci.
Aim: 1. To compare Linforoll applied force (pressure) with skin interface and subcutaneous edema fluid pressures, observe proximal movement of fluid (strain gauge plethysmography), increase of tissue elasticicty (using deep tonometer), and movement of edema fluid on lymphoscintigraphy. 2. Establish indications for Linforoll application.
Methods: Twenty-five patients with lymphedema of lower limbs stage II-III were included. Eight patients underwent implantation of silicone “new lymphatics” Linforoll massage was applied for 45 min to 8 lower limb areas.
Results: Manual massage showed unpredictable pressure values ranging between 50 and 120 mmHg. Using Linforoll we could regulate pressure in range of 50 to 80mmHg. Higher force could be applied in hard tissues. Painful areas could be detected indicating inflammatory foci requiring additional antibiotic therapy. Fluid movement in proximal direction recorded on plethysmography showed values of 2-4 ml/25 rollings/area. A significant increase in elasticity was observed in all cases. Rolling moved fluid along the implanted tubings.
Conclusions: The novelty of the device is:
1. Regulation of the applied force depending on hydromechanic conditions of the massaged tissues,
2. Standardization of massage method based on evidence and not therapist’s hand,
3. Evident increase in tissue elasticity proving less fluid,
4. Application, beside of routine massaging, as a driving force for fluid along implanted tubings and possibly lympho-venous shunts.
NEW DEVELOPMENTS IN THERAPY OF LYMPHEDEMA – LINFOROLL AND ITS APPLICATION
OLSZEWSKI W. L., ZALESKA M.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Background: Long term observations confirm durable effects and lack of complications of the intermittent pneumatic compression (IPC) therapy. So far no test has been designed providing data necessary for setting pressure and time of IPC device to obtain maximum decrease in limb volume.
Aim: To design a test providing data on decrease of circumference under inflated chamber depending on compression time and pressure.
Methods: One chamber was placed above ankle joints and inflated to 120 mmHg to occlude tissue fluid backflow during inflation of the proximally located test chamber. The latter was inflated sequentially to 50, 80, 100 and 120mmHg, for one and three minutes each. Calf circumference changes were recorded continuously using plethysmographic strain gauges placed under and proximally to inflated chamber.
Results: Four different types of recorded circumference change curves were observed. The first was decrease under and increase proximally to inflated chamber, another showed decrease under inflated chamber and little change proximally, the third small decrease under chamber but increase proximally and the fourth no change under and proximally. Depending on steepness of obtained curves pressures and timing of IPC device were set to values bringing about edema fluid mobilization.
Conclusions: Two-chamber inflation-deflation test provides data on circumference changes during calf IPC, time necessary to obtain maximum decrease of circumference and insight into tissue elasticity. These data are useful for setting compression devices at levels bringing about decrease in limb swelling and may be of prognostic value with respect to efficacy of long-term use of IPC.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015