Pappas CJ, O'Donnell TF Jr.
Long-term results of compression treatment for lymphedema.
J Vasc Surg 1992 Oct;16(4):555-62; discussion 562-4     weiter zur Übersetzten Vollversion

Department of Surgery, New England Medical Center Hospitals, Tufts University
School of Medicine, Boston, MA.

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 lymphedematous tissue was determined by the difference
between the pretreatment, postacute treatment, and long-term treatment girths at
nine points in 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 < or = 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 reduced limb girth in 90% of patients.