Limb Circumference Research Articles

One-stage circumferential limb ring constriction release and direct circular skin closure in amniotic band syndrome: a 14-case series

The aim of the present study was to report results of direct circular suture after 1-stage circumferential resection of limb ring constriction in amniotic band syndrome. A multicentre retrospective study included 14 patients with amniotic band syndrome (mean age, 13.3 months) operated on between 2004 and 2019 by circumferential release of ≥1 ring constriction. Assessment was based on limb function and clinical scar aspect on the POSAS and Vancouver scales. Mean follow-up was 3.9 years. There were no scar-related, vascular or neurologic complications, postoperatively or at last follow-up. POSAS and Vancouver scores were satisfactory. One-stage circumferential release with direct closure is a simple technique that provides satisfactory functional and esthetic results.

The Process of Improving the Patient’s Motor After a S troke Due to Craniocerebral Trauma – Case Report

Introduction: Stroke is the most common disease of the central nervous system. Whereas craniocerebral trauma is defined as the function of the skull bones, broken soft tissue continuity and / or brain contents, including cranial nerves and cerebrospinal opponents. Aim: The aim of the study was to present the importance of kinesitherapy in the process of improving a 72-year-old patient with craniocerebral trauma after an ischemic stroke of the left hemisphere of the brain. Material and Methods: The method of individual case was used in the work. The study included a patient aged 72 with craniocerebral trauma after an ischemic stroke of the left hemisphere of the brain. The description of the individual case study was based on the subject and subject tests performed before and after rehabilitation. Results: The physical examination used the Lovett test to assess muscle strength, range of joint mobility using a goniometer, measurement of limb circumferences and the Ashworth scale to assess spasticity. The tests and functional scales were carried out twice in the patient, in whom her clinical condition was assessed. Conclusions: Based on the case report, it was found that the kinesitherapy used improved the patient’s physical condition. The pain and lymphoedema she was struggling with decreased. A significant increase in the range of mobility, strength and muscle mass of the limbs affected by hemiparesis was also observed. Individually selected rehabilitation program has improved proprioception, standing and gait re-education. The patient moved with the help of orthopedic equipment in the form of elbows.

Study on the Therapeutic Efficacy of a Polyphitho Therapeutic Compound in Primary and Secondary Lymphedema.

The role of the interstitial matrix in regulating exchanges and interactions at the level of the microvascular units, between the corpuscular component and the vascular and nerve structures, has long been known. Equally known are the objective and subjective clinical manifestations that these pathologies trigger in the patient, both in primary and secondary forms: embarrassment, asthenia, alterations of exteroceptive and proprioceptive sensitivity, pain, reduced capacity, and functional autonomy, affecting both the lower and the upper limbs. The authors studied 136 patients with I and II clinical stage lymphedema according to the International Society of Lymphology stadiation. Patients were treated with Lymdiaral, 20 drops three times a day for 90 consecutive days. The following parameters were examined in basal conditions and after treatment: ultrasound measurement of suprafascial thickness, short form healthy survey version 12 (SF12), body mass index, and limb circumferences in specific points of reference. The results demonstrate the effectiveness of the therapeutic principle both in the reduction of limb circumferences and in the improvement of the parameters related to the quality of life expressed by the SF12 items. There were no substantial differences in the results between primary and secondary forms.

Effect of sedation or general anesthesia on elbow goniometry and thoracic limb circumference measurements in dogs with naturally occurring elbow osteoarthritis.

To evaluate the effect of sedation or general anesthesia (GA) on elbow goniometry and thoracic limb circumference (TLC) measurements in dogs with elbow osteoarthritis (OA). Prospective study. Twenty-four client-owned dogs with radiographically confirmed elbow OA. Elbow goniometry and TLC measurements were made before and after either sedation or GA by using a hand-held goniometer and spring tension measuring tape, respectively. Observers were not allowed to review their pre-sedation or pre-GA measurements at the time of obtaining measurements on dogs under sedation or GA. Mixed analysis of variance models were used to compare elbow goniometry and TLC measurements before and after sedation or GA. Eleven and thirteen dogs were included in the sedation and GA groups, respectively. Mean elbow flexion decreased by 5° and 3° and mean elbow extension increased by 6° and 2° under sedation and GA, respectively. Total range of motion increased by 11° under sedation and by 5° under GA. Each of these changes was statistically significant (P < .05) except elbow extension under GA (P = .129). Sedation and GA did not influence TLC measurements (P > .05). Sedation or GA led to slight and similar increase in elbow flexion and extension but did not influence TLC measurements in dogs with elbow OA. Sedation or GA can cause slight alterations to goniometric measurements in canine elbows with OA. The protocols used in this study for sedation and GA seem interchangeably acceptable for goniometry and TLC measurements in dogs with elbow OA.

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

PurposeLymphedema is a debilitating condition that significantly affects patient’s quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema.MethodsA single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes.ResultsOne hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group.ConclusionsLVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.

A New Experimental Lymphedema Model: Reevaluating the Efficacy of Rat Models and Their Clinical Translation for Chronic Lymphedema Studies.

Our aim was to create a new rodent hind limb lymphedema model lacking the fibrosis effect induced by radiotherapy and subjected to the inhibition of lymphangiogenesis via sirolimus (rapamycin) to maintain a chronic lymphedema model and investigate its reliability for human treatment modalities. Forty-two Sprague-Dawley rats were randomly assigned to 7 groups: (1) surgery control, (2) vehicle-surgery control, (3) vehicle control, (4) rapamycin control, (5) surgery with 1 mg/kg per day rapamycin, (6) surgery with 1.5 mg/kg per day rapamycin, and (7) surgery with 2 mg/kg per day rapamycin. All surgeries were performed on the right hind limbs, with the left hind limbs also considered as a control. The drug and its solvent were administered daily into the relevant groups intraperiteonally. The presence of lymphedema was investigated by weekly limb circumference measurements, microcomputed tomography, fluorescence lymphography using indocyanine green dye, and microscopic evaluation at the end of the sixth week to determine any histological changes in the hind limbs. In group 1, lymphedema was observed for 2 weeks (P = 0.032), whereas in groups 5, 6, and 7, lymphedema lasted for 3 weeks (P < 0.05.) Fluorescence using indocyanine green revealed that the edema was totally resolved after 6 weeks of surgery by a well-developed superficial lymphatic organization instead of the normal distinct vessel structure. Histologically, groups 1, 5, 5, and 7 demonstrated a significant increase in both the number of macrophages (P < 0.001) and newly formed lymphatic vessels in the right side surgically treated hind limb (P < 0.05). Despite the extreme surgical destruction and lymphangiogenesis inhibition in the rat model, the sustained lymphedema did not last >3 weeks. Because of the rapid neolymphangiogenesis in murines and a different wound healing mechanism, they should not be considered as an appropriate model for research on human lymphedema in first place.

Water Reductive Effect of Lymphaticovenular Anastomosis on Upper-Limb Lymphedema: Bioelectrical Impedance Analysis and Comparison with Lower-Limb Lymphedema.

We previously examined the water reductive effect of lymphaticovenular anastomosis (LVA) using bioelectrical impedance analysis (BIA) measurement on lower-limb lymphedema and revealed mean water volume reduction and edema reduction rate by leg LVA to be 0.86 L and 45.1%, respectively. This study aimed to clarify the water reductive effect of LVA on arm lymphedema and compare its results with those for leg lymphedema. The efficacy of LVA for unilateral arm lymphedema was evaluated using BIA in a retrospective cohort. Limb circumference and arm body water volume (ABW) of the affected and unaffected arms were measured before and after LVA. Mean water volume reduction (ΔABW) and edema reduction rate by arm LVA were compared with values for leg LVA cited from our previous report as a historical control. Nineteen consecutive patients were enrolled. The mean ΔABW and edema reduction rate by BIA were 0.267 L and 46.0%, respectively. The decreasing rate of ABW by BIA was significantly larger than those of the upper extremity lymphedema index and sum of 5 circumferences measurement methods. ΔABW could be predicted by a regression line based on the preoperative water volume difference between affected and unaffected limbs. The mean edema reduction rates for arm and leg LVA were comparable. The water reductive effect of LVA on upper-limb lymphedema was demonstrated by BIA assessment. BIA can reflect the effect of LVA more sensitively than conventional objective measurements and may facilitate the interpretation of LVA results. Although water volume reduction by arm LVA was less than that by leg LVA, the edema reduction rates were comparable.

Indirect Markers of Muscle Damage Throughout the Menstrual Cycle.

The indirect markers of muscle damage have been previously studied in females. However, inconclusive results have been found, possibly explained by the heterogeneity regarding monitoring and verification of menstrual-cycle phase. To determine whether the fluctuations in sex hormones during the menstrual cycle influence muscle damage. A total of 19 well-trained eumenorrheic women (age 28.6 [5.9]y; height 163.4 [6.1]cm; weight 59.6 [5.8]kg body mass) performed an eccentric-based resistance protocol consisting of 10 × 10 back squats at 60% of their 1-repetition maximum on the early follicular phase (EFP), late follicular phase, and midluteal phase of the menstrual cycle. Range of motion, muscle soreness, countermovement jump, and limb circumferences were evaluated prior to 24 and 48 hours postexercise. Perceived exertion was evaluated after each set. Differences in sex hormones indicated that tests were adequately performed in the different menstrual-cycle phases. Prior to exercise, muscle soreness was higher in the EFP (4.7 [7.7]) than in the late follicular phase (1.1 [3.2]; P = .045). No other variables showed significant differences between phases. Time-point differences (baseline, 24, and 48h) were observed in knee range of motion (P = .02), muscle soreness, countermovement jump, and between sets for perceived exertion (P < .001). Although the protocol elicited muscle damage, hormonal fluctuations over the menstrual cycle did not seem to affect indirect markers of muscle damage, except for perceived muscle soreness. Muscle soreness was perceived to be more severe before exercise performed in EFP, when estrogen concentrations are relatively low. This may impair women's predisposition to perform strenuous exercise during EFP.

Lymphedema microsurgery improved outcomes of pediatric primary extremity lymphedema.

Primary lymphedema is an anomaly of the regional lymphatic system with long symptom duration or severe lymphatic obstruction. Few microsurgical treatments for primary lymphedema have been reported. This aim of this study was to investigate the outcomes of microsurgical treatments in pediatric primary lymphedema patients. Between 2013 and 2017, pediatric primary lymphedema patients who underwent either lymphovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT) were retrospectively reviewed. Cheng's Lymphedema Grading, Taiwan Lymphoscintigraphy Staging and indocyanine green lymphography were used to select the procedures. No compression garments were used postoperatively. Outcome measurements included circumferential difference, episodes of cellulitis, and Lymphedema-specific Quality of life questionnaire (LYMQoL). Nine patients with mean age of 9.2 years (range, 2-19 years) with 11 lower and two upper lymphedematous limbs underwent 11 VLNT and two LVA. All VLNT flaps survived. At a mean 38.4-months (range, 16-63 months) of follow-up, the mean circumferential difference in nine unilateral lymphedematous limbs was improved by 6.7 ± 9.9% (p = .066). Two patients with bilateral lower limb lymphedema had mean limb circumference improvements of 1.3 and 6.5 cm, respectively. In nine limbs with cellulitis preoperatively, episodes of cellulitis decreased by 2.67 times/year (p = .007). At a mean 22.3-months of follow-up (range, 13-24 months), the LYMQoL overall score in 6 patients older than 7 years was improved by 3.2 ± 1.1 points (p = .007). Lymphedema microsurgery significantly improved the episodes of cellulitis and quality of life without utilizing compression garments in pediatric primary lymphedema patients.

Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema

Background: Vascularized lymph node transfer (VLNT) is a microsurgical treatment for lymphedema. Frequently used VLNT donor sites may risk donor-site lymphedema (inguinal) or require intraperitoneal harvest (gastroepiploic). The purpose of this study was to describe a novel VLNT using the deep inferior epigastric artery (DIEA) nodes. Methods: Patients who underwent VLNT using DIEA nodes between 2015 to 2019 were evaluated. Factors including age, affected limb, body mass index, co-morbidities, etiology, stage, recipient site/vessels, and arm measurements were assessed. Arm measurements at the wrist, forearm, and upper arm were recorded. Circumferential differentiation (circumference of the lesion limb minus the healthy limb, divided by that of the healthy limb) was calculated. Results: Four patients underwent VLNT using DIEA nodes. All patients were female with upper extremity breast-cancer related lymphedema. Age and BMI were 54.8 +/- 10/4 and 35.7 +/- 7.4, respectively. Patients underwent VLNT with DIEA to forearm (radial artery, n=2), wrist (bilevel VLNT with DIEA to radial artery and right gastroepiploic VLNT to axilla to n=1), and conjoined with contralateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction (n=1). There were no donor site complications. All patients reported subjective improvements of their symptoms. The mean circumferential differentiation averaged across all sites was 5.3% at 9 months. Conclusion: Vascularized transfer of the DIEA nodes is a novel technique for treatment of lymphedema. Advantages of this technique include avoiding the risk of donor site lymphedema and convenient access during abdominally based autologous breast reconstruction.

Cephalic vein patency after deltopectoral approach to the shoulder and the effect on upper extremity edema

BackgroundThe effect of the direction of cephalic vein mobilization in a deltopectoral approach to the shoulder on limb edema is unknown. The primary objective was to evaluate the effect of the direction of cephalic vein mobilization/ligation on limb edema after elective shoulder arthroplasty. The secondary objectives were to: evaluate the effect of the arthroplasty procedure performed on limb edema; correlate postoperative ultrasonographic patency with intraoperative assessment. MethodsA cohort of 62 patients undergoing primary shoulder arthroplasty using the deltopectoral approach were enrolled and prospectively followed. Exclusion criteria included: surgery for fracture and prior open anterior shoulder procedure. Surgeons documented the direction of vein mobilization and if it was ligated. Patency was assessed by doppler ultrasound and standardized limb circumference measurement preoperatively, at 2 weeks and 12 weeks postoperatively. ResultsArm circumference was significantly increased at 2 weeks in all cohorts (lateral, p<0.001; medial, p = 0.007; ligated, p = 0.011) and at 12 weeks in the laterally-mobilized (p = 0.022) and ligated cohorts (p = 0.003) as compared to preoperatively. Reverse shoulder arthroplasty demonstrated significantly greater arm circumference at 12 weeks as compared to total shoulder arthroplasty (p = 0.014). Intraoperative determination of patency was moderately correlated with 2- and 12-week (r = 0.70, 0.59) ultrasound assessment. ConclusionMedial cephalic vein mobilization in a deltopectoral approach resulted in significantly less arm edema at 3-months when compared to lateral mobilization/ligation. Reverse shoulder arthroplasty demonstrated greater arm edema at 3-months when compared to total shoulder arthroplasty. Intraoperative determination of cephalic vein patency was moderately correlated with postoperative vein patency as assessed by ultrasound. Level of EvidenceIII.

Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Extremity Lymphedema with Different Severities

BackgroundExtremity lymphedema can occur bilaterally with different severities on each side. The aim of this study is to investigate the treatment outcomes of such patients with bilateral extremity lymphedema of different severities.Patients and MethodsBetween 2013 and 2017, patients with bilateral extremity lymphedema of different severities according to the Taiwan Lymphoscintigraphy Staging (TLS) system were retrospectively reviewed. Ipsilateral vascularized lymph node transplantation (VLNT) was indicated in TLS total obstruction and contralateral lymphovenous anastomosis (LVA) in TLS partial obstruction with patent lymphatic vessels on indocyanine green lymphography. Outcomes were assessed using circumference improvement, frequency of cellulitis, and lymphedema-specific quality of life (LYMQoL) questionnaires.ResultsA total of 10 patients with bilateral extremity lymphedema with median age of 63 (range 12–75) years were included. The median symptom duration of the lymphedematous limb was 60 (range 36–168) months and 12 (range 1–60) months in the VLNT and LVA group, respectively (p < 0.05). At average follow-up of 37.5 (range 14–58) months, the average limb circumference improvement was 2.4 (range − 3.3 to 7.8) cm in the VLNT group and 2.3 (range 0.3–7) cm in the LVA group (p = 1). The median episodes of cellulitis decreased significantly from 4 to 0.5 and 1 to 0 times/year in the VLNT and LVA group, respectively (p = 0.02, p = 0.06). The overall LYMQoL score improved from 4.5 preoperatively to 7.5 postoperatively (p < 0.01).ConclusionsLimb-specific VLNT and LVA selected by TLS effectively treated bilateral extremity lymphedema with different severities.

Acetazolamide and SGLT2 inhibitor as potent drugs for a patient with diabetes mellitus and worsening chronic lymphedema: A case report

Treatment of lymphedema using a pharmacologic approach is reported to have limited efficacy. Here, I report a patient with type 2 diabetes (T2DM) and acute worsening of her chronic lymphedema, in whom treatment with acetazolamide and a sodiumglucose cotransporter-2 inhibitor (SGLT2i) effectively improved the lymphedema. A 94-year-old woman, who was treated for T2DM, hyperlipidemia, and hypertension for 17 years at my hospital presented to the emergency room because of acute worsening of her chronic right leg lymphedema with increased swelling, tightness, and dull aching. A pharmacologic approach was used to treat her worsening lymphedema. Acetazolamide 500 mg/d was administered to treat the acute tissue fluid collection in the right lymphedematous leg. Ten days later, the patient’s body weight was markedly reduced by 3.2 kg, pitting in the right leg was markedly improved, and the circumference of right limb was decreased. On day 11, the glucose-lowering agent vildagliptin was switched to the SGLT2i empagliflozin 10 mg/d. On day 70, her body weight had decreased further by 2.8 kg, and the circumference of her right limb was greatly reduced compared with that under treatment with acetazolamide. Her serum chloride concentration was increased after treatment, but her hemoglobin and hematocrit values did not change during the study period. In conclusion, acetazolamide and an SGLT2i have acute diuretic effects for draining the excess tissue fluid in the lymphedematous limb without vascular contraction by enhancing vascular tonicity. Additionally, an SGLT2i may have chronic effects for reducing fat deposits in the lymphedematous limb.

Upper-extremity blood flow restriction: the proximal, distal, and contralateral effects—a randomized controlled trial

Blood flow restriction (BFR) training with low weight is purported to induce similar physiological changes to high-weight regimens with the benefit of less tissue stress. We hypothesized that low-weight training with BFR would produce increased gains in strength and hypertrophy for muscle groups proximal, distal, and contralateral to tourniquet placement compared with low-weight training alone. In this prospective, randomized controlled trial, healthy subjects were randomized into a 6-week low-weight training program either with or without BFR on 1 extremity. Outcome measures included limb circumference and strength. Comparisons were made between the BFR and non-BFR extremities, BFR and control groups, and non-BFR extremity and control groups. A total of 24 subjects (14 BFR and 10 control subjects) completed the protocol. Significantly greater gains were observed in dynamometric strength both proximal (shoulder scaption [30% greater], flexion [23%], and abduction [22%]) and distal (grip strength [13%]) to the tourniquet in the BFR limb compared with both the non-BFR extremity and the control group (P < .05). Arm and forearm circumferences significantly increased in the BFR limb compared with the non-BFR limb and control group(P = .01). The non-BFR extremity demonstrated greater grip strength than the control group (9%, P < .01). No adverse events were reported. Low-weight BFR training provided a greater increase in strength and hypertrophy in the upper-extremity proximal and distal muscle groups compared with the control group. The non-BFR extremity showed a significant increase in grip strength compared with the control group, indicating a potential systemic effect.

The Reliability and Validity of Quality of Life Questionnaire Upper Limb Lymphedema (ULL-27) Turkish Patient With Breast Cancer Related Lymphedema.

Purpose: Breast cancer is the most common cancer amongst women both in Turkey and in the world. Lymphedema, which negatively affects the quality of life, is one of the most prevalent problems reported by breast cancer survivors. Upper Limb Lymphedama 27 (ULL-27) questionnaire is a valid and reliable tool that assesses the quality of life in patients with breast cancer-related lymphedema. Until now, a Turkish-language version was lacking. The aim of this study was to perform a cross-cultural validation and reliability of the Turkish version of the ULL-27 questionnaire.Methods: This cross-sectional study involved forward- backward translation, and cross-cultural adaptation. 81 women (mean age and body mass index 54.96 ± 11.35 years and 29.50 ± 5.74 kg/m2) who had breast cancer related-upper extremity lymphedema were evaluated using the ULL-27 Quality of life questionnaire-Turkish version. Assessment of limb size was quantified by using circumferential limb measurements. European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) were analyzed by Pearson's correlation analysis with the ULL-27 Turkish Version to indicate the convergent validity. Cronbach's alpha (internal consistency) and exploratory factor analysis were used to assess the questionnaire's reliability.Results: The mean of lymphedema duration and severity were 23.12 ± 30.88 months. Mild lymphedema was reported in 42% (34 people) of the cases included in the study. It was observed that 33.3% (27 people) had moderate lymphedema and 24.7% (20 people) had severe lymphedema. The alpha coefficient (internal consistency) for the Turkish ULL-27 total score was high (alpha = 0.93). Content validity was good because all questions were understandable for all participants (The alpha coefficient for the subgroups of the scale of physical, psychological, social scores, were 0.90, 0.87, and 0.75, respectively). External construct validity was highly confirmed by expected correlations with comparator scales, EORTC-30, and QLQ-BR23 (p < 0.01).Conclusions: The Turkish version of the ULL-27 Questionnaire is a valid and reliable tool for evaluating QoL in women with upper limb lymphedema related to breast cancer.

A Comprehensive Nonoperative Rehabilitation Program Including Blood Flow Restriction for a Talus Fracture in a Professional Hockey Player: A Case Report

A 22-year-old male professional hockey player sustained a nondisplaced talus fracture. We present a comprehensive nonsurgical rehabilitation that includes blood flow restriction (BFR) training. Pain and function measures improved throughout the rehabilitation. Lower limb circumference did not change postinjury. The patient returned to play in less than 7 weeks, while current talar fracture management protocols indicate surgical fixation and 6 weeks of immobilization. BFR training may be useful in injury rehabilitation, negating muscle atrophy and increasing muscle strength while allowing the patient to exercise at relatively low loads. This is the first case of BFR training implemented in early fracture rehabilitation of an athlete.

Effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease: a randomized controlled trial

Objective: The aim of this study was to compare the effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease (CVD). Design: This is a prospective, randomized, controlled, single-blind clinical trial. Setting: The study was conducted in a physiotherapy and rehabilitation unit of a university hospital. Subjects: A total of 62 patients with early-stage CVD were allocated to either an experimental group or a control group. Interventions: Experimental group (n = 29) received Kinesio Taping intervention once a week for four weeks, while control group (n = 29) received compression stockings for four weeks. All patients additionally undertook an exercise training programme including calf muscle pump exercises, flexibility exercises and diaphragmatic breathing. Main measures: Visual analogue scale, lower limb circumference measurements, 6-minute walk test and Short Form 36 questionnaire were applied before and after four weeks of treatment. Results: Control group showed statistically significant improvements in pain (P < 0.001), ankle circumferences (right, P = 0.002; left, P = 0.037), calf circumferences (right, P = 0.020; left, P = 0.022), knee circumference (left, P = 0.039) and thigh circumferences (right, P = 0.029; left, P = 0.002) compared with experimental group. There were no significant differences between groups with respect to functional capacity and quality of life (P > 0.05). Both groups significantly improved 6-minute walk distance (P < 0.001) and Short Form 36 physical component summary (experimental group, P = 0.002; control group, P = 0.006). Conclusion: This study demonstrated that Kinesio Taping and compression stockings revealed similar improvements of functional capacity and quality of life in patients with CVD. The symptoms of pain and edema caused by CVD can be decreased more efficiently with compression stockings than Kinesio Taping intervention.

Measuring lower limb circumference and volume - introduction of a novel optical 3D volumetric measurement system.

This study comprised two experiments: (1) the reliability of a novel optical three-dimensional (3D) volumetric measurement system (BODYTRONIC® 600) for the assessment of lower limb circumference and volume; (2) the comparison of data obtained from BODYTRONIC® 600 with that provided by computed tomography (CT) for accuracy estimation. Reliability was assessed in 20 healthy subjects. Accuracy was determined by comparing the deviations in the surface topology of two 3D models obtained from BODYTRONIC® 600 and CT. Reliability was very high for leg circumference measures [coefficient of variations (CVs) range 0.3%-1.3%] and slightly lower for foot circumference (CVs around 2.0%). Reliability of leg volume was also found to be very high (CVs ≤ 2.5%). Differences in surface topology between BODYTRONIC® 600 and CT were primarily below 1 mm indicating high accuracy. The volumes of the foot were higher (range 0.9%-1.7%) and that of the leg, lower (range 1.0%-1.3%) compared to CT. The BODYTRONIC® 600 system provides fast, highly reliable and accurate measures of lower limb circumference and volume and can be considered as a valuable measurement tool for use in various research and clinical applications.

Impact of body mass index on long-term surgical outcomes of vascularized lymph node transfer in lymphedema patients.

Vascularized lymph node transfer (VLNT) is a surgical procedure with high interest to treat lymphedema. Body mass index (BMI) is a well-described factor that increases the risk of lymphedema, but little is known about its influence on the surgical outcomes of lymphedema patients who undergo VLNT. The aim of this study was to analyze the impact of preoperative BMI on the long-term surgical outcomes after VLNT in lymphedema patients. We retrospectively compiled data of patients with International Society of Lymphology (ISL) stage II or III lymphedema who were treated with VLNT from July 2010 to July 2016 at China Medical University Hospital. Preoperative and postoperative demographic and clinical data, such as limb circumference and number of infection episodes were reviewed. Statistical analyses compared circumference reduction rates and infection episode reduction between preoperative BMI categories was done. In addition, prediction of outcomes based on quantitative preoperative BMI was analyzed. A total of 83 patients met the inclusion criteria. Nine patients (10.8%) were normal weight, 43 (51.8%) were overweight, and 31 (37.3%) were obese. Compared with normal-weight patients, mean circumference reduction rates were significantly lower in overweight (P=0.005) and obese patients (P=0.02), but quantitative BMI was not correlated with circumference reduction rate (P=0.96). However, obese patients had a significantly greater reduction in infection episodes than normal-weight patients (P=0.03). In addition, greater BMI predicted greater reduction in infection episodes after VLNT (P=0.02). VLNT is an effective surgical treatment, especially for lymphedema patients with higher preoperative BMIs. The results of our study suggest that this procedure considerably decreases the number of postoperative infection episodes per year in obese patients, even though preoperative BMI does not influence circumference reduction rate.

Relationship Between Interface Pressures and Pneumatic Cuff Inflation Pressure at Different Assessment Sites of the Lower Limb to Aid Soft Exoskeleton Design.

The aim was to develop a means of predicting interface pressure from cuff inflation pressure during circumferential compression at the lower limb, in order to inform the design of soft exoskeletons. Excessive mechanical loading of tissues can cause discomfort and soft tissue injury. Most ergonomic studies on exoskeletons are of interface pressure, but soft exoskeletons apply circumferential pressures similar to tourniquet cuffs by way of cuff inflation pressure. This study details the relationship between interface and cuff inflation pressures for pneumatic tourniquet cuffs. Pneumatic cuffs of different widths were inflated to target pressures on (A) a rigid cylinder, (B) the dominant thigh and calf, and (C) knee of healthy participants standing still. Interface pressures were measured under the cuffs using a pressure-sensing mat. Average interface pressures were then compared to cuff inflation pressures. The influence of cuff width, cuff inflation pressure, and participants' anthropometric data on pressure transmission was assessed. A strong linear relationship between cuff inflation pressures and interface pressures was observed. Interface pressures were generally higher than cuff inflation pressures. The efficiency of pressure transmission to the lower limb depended on assessment site, adipose tissue thickness, cuff size, cuff inflation pressure, and possibly limb circumference. Regression equations were developed to predict interface pressures at the thigh, calf, and knee. Interface pressures under pneumatic cuffs are influenced by the cuff size, cuff inflation pressure, and tissue compressibility. Predicted interface pressure from cuff inflation pressure and vice versa can be used to aid the design of soft exoskeletons.