Lymphedema of lower limbs is a consequence of an obstruction of the main lymphatics caused by inflammation, trauma, excision of lymph nodes, and irradiation. In a percentage of cases, the etiology remains unknown and the term “idiopathic” is being used. Lymphedema has been defined as an abnormal accumulation of capillary filtrate with proteins, cytokines, and chemokines, recirculating lymphocytes, products of parenchymatous cells, and debris of senescent cells. Edema of tissues develops once the intercellular space has been filled with stagnant fluid (1).
Persons afflicted with lymphedema have significant problems such as impaired extremity function, recurrent episodes of soft tissue inflammation (dermatolymphangioadenitis), lymphorrhea, and unsatisfactory cosmesis, and a variety of psychological and social issues (1)
Recent developments in technology have allowed intermittent pneumatic compression (IPC) devices to be developed so that their function mimics the process and principles of manual lymphatic drainage (MLD).
The research has found that patients using regular IPC have a reduction in limb volume and an improvement in their quality of life (2). IPC that mimics the MLD process has been shown to be more effective in reducing leg volume compared with traditional sequential IPC in the distal aspect of the leg. Furthermore, research indicates that there is a significant increase in leg volume after the discontinuation of IPC, which again strongly suggests that regular treatment is required to maintain its associated effects (2).
When using IPC, the research showed that pressure ranging from 50 -120mmHg and 50 seconds to reach head pressure allowed for the best results (4). It was also noted that a permanent decrease in limb circumference and increased elasticity of tissues was recorded. This was most expressed in the calf above the ankle and mid-calf (3).
No complications in limb tissue or venous flow were observed, making long-term IPC a safe therapy for patients with lower limb lymphedema.
Reference
(1) Zaleska M, Olszewski WL, Durlik M. The effectiveness of intermittent pneumatic compression in long-term therapy of lymphedema of lower limbs. Lymphat Res Biol. 2014 Jun;12(2)
(2) Dunn N, Williams EM, Dolan G, Davies JH. Intermittent Pneumatic Compression for the Treatment of Lower Limb Lymphedema: A Pilot Trial of Sequencing to Mimic Manual Lymphatic Drainage Versus Traditional Graduated Sequential Compression. Lymphat Res Biol. 2022 Oct(5)
(3) Zaleska M, Olszewski WL, Durlik M. The effectiveness of intermittent pneumatic compression in long-term therapy of lymphedema of lower limbs. Lymphat Res Biol. 2014 Jun;12(2)
(4) Zaleska M, Olszewski WL, Jain P, Gogia S, Rekha A, Mishra S, Durlik M. Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with lymphedema. Lymphat Res Biol. 2013 Dec;11(4)
