Laser Therapy in Comprehensive Treatment of Patients with Lymphedema of Lower Limbs

Abstract

INTRODUCTION: Methods of physiotherapy using intravenous laser irradiation of blood (ILIB) that affects various pathogenetic factors of lymphedema, permits to achieve the required therapeutic effect and shows its promising perspectives.
 AIM: Evaluation of the effectiveness of ILIB to reduce the lymphedema volume in the lower limbs.
 MATERIALS AND METHODS: In 2020–2022, a comprehensive conservative treatment including compression therapy, pharmacotherapy and ILIB, was conducted in 60 patients of the mean age 45.3 ± 1.6 years with I–III stage lymphedema. Group 1 included patients with primary (n = 8) and group 2 (n = 52) with secondary lymphedema of the lower limbs. Laser radiation at 632 nm wavelength was used with standardized parameters: power 3 to 15 mW, pulse rate 80 to 2,000 Hz, exposure time 5 to 15 min, with a course (up to 10 sessions), daily, or interval (every 2nd day) load. Lymph outflow, microcirculation, soft tissues of the affected limb were evaluated using electrocoagulography, ultrasound examination of inguinal lymph nodes and soft tissues, triplex scanning, thermal imaging and McClure-Aldrich test.
 RESULTS: At the end of the treatment course, a reduction of the limb perimeter at the level of the middle third of the lower leg by 14.8 ± 0.7% was noted (from 48.7 ± 5.3 cm to 41.4 ± 0.9 cm). After 4 sessions and a treatment course, electrocoagulography revealed hypocoagulation with the formation of a loose clot with early retraction. Spearman test showed a direct relationship between changes in the fibrinolytic activity of blood and the perimeter of the lower leg in patients of group 2 with I–II stage of the disease (p 0.005). Thermography of the lower limbs showed increased IR radiation with a statistically significant increase (p 0.001) in the area of hyperthermia in the distal parts of the lower legs and the inner surface of the thighs. The results of McClure-Aldrich test showed a statistically significant slowdown of a skin papule resolution in the distal part of the lower legs from 27.13 ± 2.77 min to 35.72 ± 3.11 min (р 0.05) after ILIB in I stage of the disease.
 CONCLUSION: ILIB affects the internal factors of lymph outflow and contributes to its optimization in the comprehensive treatment of patients in the initial stage of secondary lymphedema of the lower limbs.