Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size.

OBJECTIVE: The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. METHODS: Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. RESULTS: On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). CONCLUSION: Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.

Preoperative preparation of a patient with grade II leg Lymphedema for his third hip replacement surgery.

INTRODUCTION: The treatment of lymphedema remains a challenge to modern medicine, due to the characteristics of the disease. CASE PRESENTATION: Report on the case of a 75-year-old patient with lower limb lymphedema for treatment prior to surgery. At age 45, he made the first hip replacement surgery in the left leg. One year later he performed the same surgery on the right leg. At that time his legs had slight ankle edema mainly of the left leg and the entire left leg was affected by lymphedema. At 68 years old the patient returned to the surgeon, who indicated a third surgery to replace the left hip prosthesis. The patient was evaluated by bioimpedance, which measured the volumes of right and left legs at 5.52 and 7.24l, respectively. Five days of intensive treatment were proposed using Mechanical Lymphatic Therapy (RAGodoy®), Manual Lymphatic Therapy and compression therapy with a grosgrain stocking for 24h per day. On the fifth day, there was significant improvement in the volume (right leg 4.45l and left leg 5.57l). DISCUSSION: In this case report intensive treatment was used to reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema. Small positive and negative changes, which are common in the evolution of this type of case but the end result was a total reduction of the edema. CONCLUSION: The patient underwent surgery to replace the prosthesis after total reduction of edema.

Reduction of Pain and Edema of the Legs by Walking Wearing Elastic Stockings.

Aim. The objective of the current study was to evaluate the reduction of edema and pain with the use of elastic stockings. Method. The effect of walking on a treadmill for 50 minutes in the evening wearing elastic compression stockings on pain and edema was evaluated in a prospective randomized crossover clinical trial. In Assessment 1, the legs of participants were measured by volumetry at 7:00 a.m. and they were asked to perform their normal daily activities and to return at 4:00 p.m. Forty-two legs of 21 female patients with ages of the participants ranged from 32 to 72 years with signs and symptoms of chronic venous disease. The sizes of the legs of all patients were evaluated by water displacement volumetry and a visual analog scale was used to assess pain. Results. After walking for 50 minutes on the treadmill, the volume reduced (paired t-test: p value < 0.03). In relation to pain, there was a reduction in pain after the treadmill session using the elastic stocking (Wilcoxon signed rank test: p value < 0.007). Conclusion. The reduction of edema and pain of the legs during the course of the day can be accomplished with the use of elastic stockings, as well as walking.

Synergistic effect of adjustments of elastic stockings to maintain reduction in leg volume after mechanical lymph drainage.

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value < 0.0001). Adjusting the compression provided by elastic stockings according to the size of the leg has a synergistic effect in reducing volume during mechanical lymph drainage.

Synergistic effect of elastic stockings to maintain volume losses after mechanical lymphatic therapy.

The objective of the current study was to assess whether Venosan elastic stockings have a synergistic effect on the maintenance of results after Mechanical Lymphatic Therapy. Eleven patients with grade II lymphedema of the legs, regardless of cause, were evaluated in the Clinica Godoy between September and November 2012. The participants' ages ranged from 53 to 83 years old with a mean of 65.1 years. Two groups were formed with Group I using Venosan elastic stockings and Group II not using any type of compression therapy. Evaluations of the lymphedematous legs were performed before and after each drainage session using bioimpedance. Patients who wore elastic stockings had a greater volume reduction than those who did not wear stockings (unpaired t-test: P value < 0.001).