Christos J. Pappas, MD, and Thomas F. O'Donnell, Jr., MD, FACS, Boston, Mass. J Vasc Surg 1992;16:555-564.

Although numerous operations have been devised for lymphedema, most surgeons manage this vexing condition by nonsurgical means. Previous studies by us showed that high-pressure (90 to 100 torr) sequential external pneumatic compression (SEP) reduced both limb girth and volume in a lymphedematous extremity. To assess the long-term effects of a program entailing (1) SEP, (2) elastic compression stockings to maintain the post-SEP girth, and (3) daily skin care, we reviewed the long-term courses of 49 patients managed by one surgeon. Limb girths measured at nine levels on the limb were obtained serially in follow-up (mean 25 months) by an independent observer to provide an objective response to therapy. The relative reduction in lymhedematous tissue was determined by the difference between the pretreatment, postacute treatment, and long-term treatment girths at nine points on the limb. In long-term follow-up, 26 of the patients maintained a full response (reduction at >3 levels), whereas 10 maintained a partial response (reduction at <=3 levels). At late follow-up, calf and ankle girths were reduced by an absolute value of 5.37 +- 1.01, and 4.63 +- 0.88 cm in the full-response group and 5.43 +- 1.58 and 3.98 +- 1.18 cm in the partial response group over pretreatment measurements. The degree of subcutaneous fibrosis in relationship to the duration of the edema appeared to influence results greatly. The treatment of lymphedema with SEP and compression stockings is associated with long-term maintenance of reducd limb girth in 90% of patients.

Arch Surg 1985 Oct;120(10):1116-1119 Richmand DM, O'Donnell TF Jr, Zelikovski, A

We examined prospectively the effect of a new compression device for lymphedema, which utilizes a short duration and high-pressure cycle, that provides a sequential milking pattern to the limb through multiple compartments. Twenty-five patients (seven patients for upper-extremity and 18 for lower-extremity problems) underwent 24 hours of treatment. All extremities showed a decrease in circumferential measurements with the maximal reduction occurring at the wrist (45%) for the upper extremities and at the mid-calf (47%) for the lower extremities. Lower-extremity leg volume was reduced by 45%. Despite the high pressures no elevation in serum muscle enzyme levels was noted. This device reduced lymphedematous limbs rapidly and safely.

Lymphology. 2001 Dec;34(4):156-65. 
Hassall A, Graveline C, Hilliard P. 
Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Canada.

We studied the effects of the Lymphapress pump (LP; Global Medical Imports, Digby, NS, Canada) retrospectively on 16 children with primary or secondary lymphedema of the upper or lower extremities by measuring the volume and circumference of the limbs before and after treatment. We reviewed medical charts for data on age, sex, length of disease process, grade of lymphedema, frequency and duration of treatment, and pump pressures used. We recorded changes in limb size before and after pumping in terms of the mean percentage difference between the affected and unaffected limb at both time points to allow for growth of the child and the extremity. On volumetric measures, thirteen (93%) of the subjects showed a clinical trend towards sustained maintenance or reduction in size of the lymphedematous limb(s). The reduction in the pump pressure at start of the treatment to that required to maintain the size of the limb was statistically significant (p = 0.0036). Fourteen (88%) of the subjects had no complications directly attributable to the pump, whereas two had complications that were probably unrelated to LP. Overall, there was a clinical trend towards reduction or maintenance of the lymphedematous limb size in children using LP without notable adverse sequelae.

Z Lymphol. 1981 Jul;5(1):35-9. Related Articles, Links 
Partsch H, Mostbeck A, Leitner G.

The following effects of a massage by the Lymphapress apparatus could be demonstrated by girth measurements and nuclear medical investigations on the treated extremity: 1. Volume reduction (in lymphedema in average 4,6% of the basic extremity volume after 3 h). 2. Improvement of the lymph kinetics in cases with intact or decreased lymph transport. If isotopic lymphography failed to show any lymphatic transport as in cases with severe, indurated lymphedemas no effect on the lymph kinetics could be demonstrated. 3. Decrease of albumin content in the tissues. However there is an increase of local albumin concentration in lymphedema by overproportional water reduction. Therefore compression bandages should be applied between the Lymphapress massages for maintenance of the effect.

A. Zelikovski, I. Melamed, I. Kott, M. Manoach, and I. Urca
Folia Angiologica, Vol. XXVIII:165-169

The "lymphapress" is a new intermittent pneumatic machine which in our experience has more physiological effect than the conventional machines. In a series of 25 women with post-mastectomy lymphedema, reduction of edema between 36% to 70% by using volume and circumference measurements was found in 80% of the patients. THe almost complete absence of side effects as welll as the satisfactory results obtained recommend the use of this machine as an effective device for the treatment of lymphedema

Translated from the original, Rehabilitacion (Madr) 1998:32:234-250.

AUTHORS
Miguel Angel Gonzalez Viejo (*), M? Jesus Condon Huerta (**), Margarita Lecuona Navea (***), T. Etulain Marticorena (****), M?.A. Ruiz Arzoz (****), M. Arenas Paos (****).

* Hospital Universitari Germans Trias i Pujol. Badalona
** Hospital Virgen del Camino. Pamplona
*** Hospital Ntra. Sra. de Aranzazu. San Sebastian
**** Physical Therapist

Correspondence: 
Miguel Angel Gonzalez Viejo. Servicio de Rehabilitacion. Hospital Universitario Germans Trias i Pujol. Carretera Canyet sn. Apartado correos 72. 08916 Badalona. Spain.

ABSTRACT 

The study comprised a total of 14 patients, including 13 women and one man, affected by lymphedema of upper limb.

In thirteen cases the lymphedema was secondary to breast cancer. Eight cases were treated by modified Madden radical mastectomy and ganglionic axillary drainage. One case was treated by tumorectomy and radiotherapy, two by quandrantectomy and radiotherapy, one by Halsted radical mastectomy, and one by radiotherapy. Lastly, the only case that was not due to breast cancer involved a lymphedema secondary to an axillary lymphadenectomy owing to ganglionic metastasis of an undifferentiated malignant tumor, whose primary tumor could not be located.

We determined the efficiency of the multicompartment sequential pneumatic compression therapy during two weeks of treatment, in ten sessions of one hour each, by determining the volume in cubic centimeters (cc) of the healthy and affected limbs according to the measurement of the girth, in centimeters, at seven levels along the limbs.

The average volumes showed statistically significant differences on the first day, before and after treatment (p=0.007) and the fourth day (p=0.001), but not on the sixth or the eighth days. However, we did find significant differences between the volumes on the first day before treatment and the last day after treatment (p=0.007).

We consider that multicompartment sequential pneumatic compression therapy has a place in the treatment of lymphedema of the upper limb, which was the subject of our study, always in combination with other physical therapy techniques, such as manual lymphatic drainage.

KEY WORDS: LYMPHEDEMA, COMPRESSION THERAPY.

Cancer Nurs. 1995 Jun;18(3):197-205.
Mirolo BR, Bunce IH, Chapman M, Olsen T, Eliadis P, Hennessy JM, Ward LC, Jones LC.

Wesley Clinic for Haematology and Oncology, Wesley Medical Centre, Brisbane, Australia.

The effect of a comprehensive lymphedema management program was assessed in 25 patients in whom moderate to severe lymphedema had developed after surgery and/or radiotherapy for carcinoma of the breast. Intensive treatment (4 weeks) involved massage, compression bandaging, and sequential pneumatic compression, with an adjunct program of education to provide skills in exercise, massage, bandage, and containment garment use. The intensive treatment phase was followed by a self-management phase based on the skills that had been acquired. A significant reduction in limb circumference and volume, with continuing improvement over 12 months of self-management, was observed. There was a decrease in need for physical assistance. Quality of life generally remained high and stable throughout the 12 months. Quality of life specific to lymphedema, however, declined during the intensive phase of treatment, but recovered and surpassed pretreatment levels during the self-management phase of treatment. Perceived comfort and strength in the lymphedematous limb improved, and perceived size decreased. The study confirmed that the combination of multimodal physical therapy and education for self-management reduces lymphedema and its adverse subjective consequences and maintains the improvement thus achieved.

F-J. Schingale, Lymphologie in Forschung und Praxis, Special Edition February 1999

33 year old female patient with monstrous elephantiasis with primary lymphedema, which began at age 9 with increasing leg size, bedridden since 1992. The only treatment attempt in 17 years was exploratory surgery consisting of opening the entire left leg laterally. The patient began treatment in the Lympho-Opt Clinic on 28 January, 1999. On 4 March, 1999, the patient walked outside the building after 17 years of being housebound. She was discharged after six months with a volume reduction of 81.2 kg!

Keywords: primary lymphedema, elephantiasis, lymphedema therapy.

Natl Med J India. 2002 Jul-Aug;15(4):192-4. 
Manjula Y, Kate V, Ananthakrishnan N. Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

BACKGROUND: Lymphoedema is a major cause of morbidity in patients with lymphatic filariasis. There is no effective medical treatment and the results of surgery are uncertain. There are very few published studies assessing the volumetric response to the use of sequential intermittent pneumatic compression (SIPC) in patients. METHODS: A 12-celled instrument capable of providing sequential compression from the distal to proximal direction was used in 28 patients with unilateral grades II (n=17) and III (n=11) filarial lymphoedema in a planned 4-week session. The patients were followed up for 6 months after compression therapy by water displacement volumetry. RESULTS: We found that 12 patients with grade II filarial lymphoedema had >26% reduction in oedema volume immediately after compression, but this reduction (>26%) was maintained in only 7 at 6 months. The corresponding figures for grade III filarial lymphoedema were 6 and 4, respectively. The effect in grade III was less sustained than grade II. No complications attributable to SIPC were seen. An added advantage of SIPC was a significant decrease in attacks of adenolymphangitis after compression when compared to pre-compression frequency. These observations were seen even with non-compliance to both foot care measures and use of bandages to maintain reduction in oedema volume. CONCLUSION: SIPC reduces morbidity in filarial lymphoedema though the effect is not sustained. It is simple, easy to use and could form part of the morbidity control programme for lymphatic filariasis.