Effectiveness and Safety of Complete Decongestive Therapy of Phase I: A Lymphedema Treatment Study in the Greek Population.

Emmanouil Michopoulos,Evangelos Dimakakos,George Papathanasiou,Georgios Vasilopoulos,Maria Polikandrioti

doi:10.7759/cureus.9264

Abstract

BackgroundLymphedema is a chronic condition caused by a failure in the lymphatic system that most commonly occurs in the limbs. Complete decongestive therapy (CDT) is the gold standard for lymphedema management.ObjectiveTo evaluate the effectiveness and safety of complete decongestive therapy (CDT) of phase I in the Greek population with lymphedema.MethodsThe patients’ demographic and clinical characteristics were recorded. CDT was implemented in all patients for 20 sessions in a four-week treatment period. The edema’s (excess volume (EV) and percent of excess volume (PEV)) measurements were carried out four times in the treatment period, whereas the percent reduction of excess volume (PREV) was calculated at the end of phase I. Moreover, we recorded every infection, trauma of skin, and pain of limb during the treatment.ResultsOne-hundred five patients with lymphedema were enrolled in the present study, of whom 31.4% had upper limb lymphedema and 68.6% had lower limb lymphedema. All patients with upper limb lymphedema had a secondary type while the corresponding proportion of patients with lower limb lymphedema was 58.3%. A significant reduction (p<0.001) between the pre-treatment and post-treatment values of EV and PEV was found for both upper and lower limb lymphedema. For patients with upper limb lymphedema, the average PREV was 66.5% (interquartile range, 57.3%-80.6%), whereas for patients with lower limb lymphedema, a 71.5% (interquartile range, 64.5%-80.7%) median value was measured. No side effects from the treatment were recorded during CDT.ConclusionThe proper treatment of the CDT phase I ensures safety and a great reduction in edema in patients with lymphedema that predispose the success of phase II of CDT.

Highlights

The lymphatic system consists of vessels that collect and drain lymph fluid from the skin, tissue, muscle, and bone
The edema’s (excess volume (EV) and percent of excess volume (PEV)) measurements were carried out four times in the treatment period, whereas the percent reduction of excess volume (PREV) was calculated at the end of phase I
No side effects from the treatment were recorded during Complete decongestive therapy (CDT)

Summary

Introduction

The lymphatic system consists of vessels that collect and drain lymph fluid from the skin, tissue, muscle, and bone. Lymphedema occurs when there is some sort of disruption to one or more of these functions, and it can be either heritable or an acquired form [2]. This insufficiency of the lymphatic system causes an accumulation of protein-rich interstitial fluid, leading to distention, the proliferation of fatty tissue, and progressive fibrosis [3]. 80% of lymphatic drainage must be nonfunctional before lymphedema becomes clinically evident [4]. It is more commonly noted in the limbs, but it can affect the head, neck, breast, or genitalia [3]. Complete decongestive therapy (CDT) is the gold standard for lymphedema management

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Conclusion