[Lymphedema of the limb: predictors of efficacy of combined physical therapy].
BACKGROUND
Limb lymphedema results from incompetence of the lymphatic system, and treatment of both primary and secondary forms involves manual lymphatic drainage and support. The effectiveness of treatment varies from patient to patient and can be unpredictable.


OBJECTIVE
To investigate clinical and paraclinical criteria able to predict responses to combined physical treatment (lymphatic drainage and multilayered support) during hospitalization.


METHODS
A retrospective study was performed in 45 patients admitted for one week's intensive treatment of limb lymphedema in the Lymphology Unit of the Department of Dermatology of the University Hospital of Tours. Lymphoscintigraphy was performed for all patients on admission. Loss of volume in affected limbs was studied to evaluate the effectiveness of treatment.


RESULTS
Two criteria were predictive of resistance to combined treatment, i.e. venous insufficiency and continuing lymph node evidence of scintigraphic activity four hours after lymphoscintigraphy. The two factors were significantly related.


CONCLUSIONS
Failure of combined physical treatment for lymphedema appears to be related to venous insufficiency. It is therefore essential to investigate and treat venous insufficiency, particularly in patients with continuing evidence of scintigraphic activity in lymph nodes.
Gironet
N
N
Dermatologie et Unité de Lymphologie, CHU Trousseau, 37044 Tours Cedex, France.
Baulieu
F
F
Giraudeau
B
B
Machet
L
L
Toledano
C
C
Tiguemounine
J
J
Lorette
G
G
Vaillant
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D004322:Drainage; D005121:Extremities / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008209:Lymphedema / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000150:complications*