High Pressure 3 × 30 Minute Compression Methods for Advanced Lower Limb Lymphedema Patients.

In advanced lymphedema of lower limbs, stage III bandaging under the routinely applied pressure of 40-60 mmHg remains largely ineffective. This is caused by skin and subcutaneous tissue stiffness due to fibrosis. Edema fluid accumulates deep in the subcutaneous tissue.

Lymphatic Vascular Insufficiency and Focal Edema in Early Stages of Noncancer-Related Lymphedema.

Lymph flows along the lymphatics due to spontaneous contraction. However, injury and inflammation may deteriorate lymphatic' s endothelial and muscle cells and valves. In consequence, lymphatic vessels (LVs) become insufficient.

Lower Limb Lipedema-Superficial Lymph Flow, Skin Water Concentration, Skin and Subcutaneous Tissue Elasticity.

Lipedema of lower limbs is characterized by bilateral accumulations of excess adipose tissue starting from the ankle to the hips and buttocks. The studies with lymphoscintigraphy (LSC) and magnetic resonance (MR) lymphography show altered transport index and enlarged lymphatic vessels (LVs). Our studies aimed to investigate the superficial lymph flow, water accumulation, skin and subcutaneous tissue elasticity, and the possibility of using this information to diagnose lipedema.

Long-Term Benzathine Penicillin Prophylaxis Lasting for Years Effectively Prevents Recurrence of Dermato-Lymphangio-Adenitis (Cellulitis) in Limb Lymphedema.

The lymphedema-affected limbs are predisposed to acute and, subsequently, chronic dermato-lymphangio-adenitis (DLA) episodes in around 40%-50% of cases, irrespective of what the primary etiological factor is for the development of this condition. DLA is of bacterial etiology, and it needs antibiotic control and prevention of recurrence. Our aim was to follow the effects of years-long continuous no-break administration of benzathine penicillin on the recurrence of acute DLA episodes.

The long-term arterial assist intermittent pneumatic compression generating venous flow obstruction is responsible for improvement of arterial flow in ischemic legs.

Background: There is a large group of patients with ischemia of lower limbs not suitable for surgical reconstruction of arteries treated with the help of external assist by intermittent pneumatic compression devices (IPC). Until recently the generally accepted notion was that by compressing tissues below the knee, veins become emptied, venous pressure drops to zero and the increased arterial-venous pressure gradient enables greater arterial flow. We used a pump that, in contradiction to the "empty veins" devices, limited the limb venous outflow by venous obstructions and in a long period therapy expanded the perfusion vessels and brought about persistent reactive hyperemia.

The Neglected Leg Lymphatic Vascular Changes in the Pathomechanism of Delayed Onset Muscle Soreness in Runners.

Delayed onset muscle soreness (DOMS) in runners is classified as a leg muscle strain injury and presents with tenderness or stiffness to palpation and movement limitation. Most attention is directed at muscles but not at the mass of other limb soft tissues, including their lymphatic vasculature, although they undergo mechanical stress and bruises, edema, nail destruction, and pains contributing to symptoms. The study was done on lower limbs of long-distance runners suffering from DOMS complaints.

Tissue Structure and Edema Fluid Events During Treatment of Lymphedema of Limbs with a Manual Pressure-Calibrated Device, Linforoll.

Linforoll is a device composed of handpiece with roller and pressure sensor connected wireless to the computer displaying the pressure curve of the applied force. In a previous study, we proved it to regulate the applied force according to the hydromechanic conditions of the massaged tissues. Standardization of massage based on applied force was repeatable in the same patient; it decreased limb volume and provided evident increase in tissue elasticity.

Edema Fluid Can Be Successfully Evacuated from the Lymphedematous Limbs by Implantation of Silicone Tubings Bypassing the Site of Flow Obstruction Long-Term Observations.

Lymphedema of limbs is caused by partial or total obstruction of lymphatic collectors. In advanced cases all main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces. The microsurgical lympho-venous shunts cannot be performed.

The Effectiveness of Intermittent Pneumatic Compression in Therapy of Lymphedema of Lower Limbs: Methods of Evaluation and Results.

Background: Evaluation of intermittent pneumatic compression (IPC) in lymphedema is classically based on measurements of circumferences and volume of the edematous limb. However, although important, it provides only a general information without insight into what proceeds under the skin with respect to hydromechanical and structural changes.

Aim And Methods: We present the multimodal evaluation of the effectiveness of IPC device in limb edema by measuring tissue stiffness, fluid pressure, and flow volume, and lymphoscintigraphic and near-infrared fluorescence (NIRF) indocyanine green (ICG) lymphography imaging of edema fluid movement, before and after one 45-60 minute compression cycle in over 50 patients with lymphedema stage II and III.

Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).

Background: Lymphedema of limbs affects a large mass of tissues. Pathological changes develop in skin and subcutaneous tissue. Bacterial retention in edema fluid is followed by chronic inflammatory reaction.

Imaging lymphatics in human normal and lymphedema limbs-Usefulness of various modalities for evaluation of lymph and edema fluid flow pathways and dynamics.

The human lymphatic system morphology and function still remain largely unknown to clinicians and biologists. How does the lymphatic vascular system look like in comparison to the blood transport system, how does lymph flow, where does capillary filtrate accumulate in cases with lymphatic obstruction caused by inflammation, trauma, and cancer therapy, remain as basic questions. Visualization of the lymphatic pathways and dynamics of lymph flow, and in cases of obstruction, the localization of the capillary filtrate/edema fluid accumulation becomes indispensable.

Tonometry of Deep Tissues for Setting Effective Compression Pressures in Lymphedema of Limbs.

Background: The therapeutic intermittent pneumatic compression (IPC) pressures are usually set arbitrarily at levels between 40 and 60 mmHg. However, it is not known how much force has been transferred to edema fluid. There is a need to know how high edema fluid pressures should be generated to evacuate the stagnant fluid.

Predilection to Dermato-Lymphangio-Adenitis in Obstructive Lymphedema of Lower Limbs Depending on Genetic Polymorphisms at TNFα-308G>A, CCR2-190G>A, CD14-159C>T, TLR2 2029C>T, TLR4 1063A>G, TLR4 1363C>T, TGFβ 74G>C, and TGFβ 29T>C.

Background: Infection is the most common type of complication observed in lymphedema and is promoted by lymphatic system dysfunction, which causes locoregional immune disorders. Infectious complications are primarily bacterial and most commonly cellulitis (dermato-lymphangio-adenitis, DLA) caused by patients' own skin Staphylococci epidermidis and aureus. The clinical course and outcomes in the immune response to infection have been shown to be associated with genetic polymorphisms.

Indocyanine green near-infrared lymphangiography for evaluation of effectiveness of edema fluid flow under therapeutic compression.

The commonly used modalities for therapy of limb lymphedema are manual lymphatic drainage, manual devices moving edema fluid and intermittent pneumatic compression (IPC). What seems to be necessary for validation of the effect of the compression procedure is imaging of the mobilized moving edema fluid. Picture of edema fluid flow would allow the therapist to use force adjusted to the tissue volume and stiffness differing in various limb regions as well as identify sites of abundant accumulation of fluid requiring more compression.