Real-Time Direct Evidence of the Superficial Lymphatic Drainage Effect of Intermittent Pneumatic Compression Treatment for Lower Limb Lymphedema.
Intermittent pneumatic compression (IPC) is a widely used lymph drainage therapy that can be performed at home. However, the effectiveness of IPC for lymph drainage remains unclear. The aim of this study is to investigate the real-time change in the lymph flow velocity during IPC and consider which mode and pressure are best for treating lower limb lymphedema.



Eight lower left limbs of 8 healthy volunteers and 17 lower limbs of 15 secondary lymphedema patients were investigated. Indocyanine green lymphography was performed with the subject covered with a transparent six-chambered IPC garment. The IPC treatment was administered in several modes (sequential or nonsequential inflation mode, sequential or interrupted deflation mode, and under high or low pressure). Using a brightness intensity analysis software program, the real-time change in the fluorescence intensity during the treatment was recorded and graphed. The maximum inclination of the graph between 2 seconds in the inflation phase (SLOPE) and the mean SLOPE value of all subjects (average SLOPE) were calculated. The average SLOPEs of each mode of treatment were then compared. The average SLOPEs were also compared between patients with mild and moderate lymphedema. There were no significant differences among the SLOPEs in the healthy group. However, in the patient group, the average SLOPE was significantly higher in the sequential inflation mode as well as under high pressure than in the nonsequential inflation mode. On comparing the mild and moderate lymphedema groups, the average SLOPE tended to be higher in the mild group; however, the difference was not statistically significant.



Sequential programs and high pressure resulted in a faster lymphatic flow than other modes. These results suggest that a greater treatment effect could be obtained by adjusting the mode of treatment and the pressure of IPC.
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Shinya
S
Kitayama
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Jiro
J
Maegawa
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Shinobu
S
Matsubara
2 Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center , Yokohama, Japan .
Shinji
S
Kobayashi
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Taro
T
Mikami
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Koichi
K
Hirotomi
1 Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine , Yokohama, Japan .
Shintaro
S
Kagimoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D035002:Lower Extremity / Q000503:physiopathology*; D042601:Lymphatic Vessels / Q000503:physiopathology*; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods; D011312:Pressure; D016896:Treatment Outcome; D055815:Young Adult
indocyanine green (ICG) lymphography; intermittent pneumatic compression (IPC); lymph flow velocity; real-time direct evidence