A Comparison of Compression Pumps in the Treatment of Lymphedema

Abstract

Purpose: This study was done in order to ascertain which methods of mechanical compression would be optimum in treating patients with primary and secondary lymphedema. Materials and Methods: Thirty-five patients (26 women, 9 men) were enrolled in the study. The women ranged in age from 36 to 82 years (mean 56.9 years). The men ranged in age from 31 to 83 years (mean 56.4 years). Ultimately, 32 patients completed the study. Each patient was treated by random assignment to each of the three types of compression pumps. The treatment arms were as follows: (1) unicompartmental nongradient pump with pressure of 50 mm Hg, (2) a three-compartment pump with segmental, nongradient pressures of 50 mm Hg in each of three cells, and (3) a multicompartmental gradient pressure pump with ten cells ranging in pressure from 80 at the most distal to 30 at the most proximal. There were 35 extremities treated by each of the three methods. Eleven had primary lymphedema and 24 had secondary lymphedema. Results: The mean percentage volume change was +0.4% in the limbs treated with the unicompartmental pump, +7.3% in the three-compartment pump, and -32.6% in the ten-compartment pump. By use of Kruskal and Wallis, one-way ANOVA on ranks, a significant difference between the three treatments was detected (p < 0.001). In treatment of primary lymphedema there was no difference between the subgroups with regard to the effect of the three compression pumps. In treatment of secondary lymphedema, there was no reduction in the size of the limbs treated with the single-compartment, there was a -4.65% reduction in the three-compartment pump treatment, and -28.4% in the tencompartment pump. There were no differences in treatment of secondary limbs with and without radiation. In an analysis comparing primary to secondary lymphedema with and without radiation, the results were not statistically different from one another. Other factors such as severity of lymphedema, gender, duration of lymphedema, history of infection, and presence of radiation could not be implicated as having prognostic significance or having any effect on response to therapy. Conclusions: Mechanical external pneumatic compression can produce a reduction in treated limb volumes in primary and secondary lymphedema. This is best achieved by multicompartment sequential compression. Limb volume reduction by single or three compartment devices is decidedly less effective in treatment of lymphedema.