October 2004 Edition
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Combined Modality Treatment of Lymphedema using the ReidSleeve and the BioCompression/Optiflow System
In this lymphedema eNews, I will discuss our recent results using a combination of the ReidSleeve with the BioCompression pump and Optiflow insert to treat lymphedema. We tested a combination of these two approaches because of the possibility of enhancing treatment for both the acute and chronic components of lymphedema. The results demonstrate that the combination of these two approaches can significantly enhance the treatment of lymphedema.
The ReidSleeve was used nightly, the BioCompression/Optiflow system was used for 2 periods of 60 minutes during the day and level II compression sleeves were used for the remainder of daytime wear. The results from this study demonstrated marked reduction of lymphedema of the upper and lower extremity of patients with moderate to severe lymphedema refractory to other treatments. Patients with upper extremity lymphedema demonstrated a 25% reduction at 4 weeks, 50% reduction at 16 weeks and 80% reduction at 28 weeks (Fig. 1).
A plateau in response can be seen between weeks 4 and 8 among these patients. The initial rate of reduction was 6.2% per week (Fig. 1). Following a leveling off or plateau period, further reductions are observed, however, the rate of reduction is 3.1% per week. Further reductions in lymphedema and improvements in skin tone and color were achieved over the course of treatment. The slower rate of improvement with visual improvement in the skin tone and texture is consistent with gradual resolution of the tis sue abnormalities associated with lymhedema and demonstrates that the use of this system provides adequate control of lymphedema without causing increased stress on the tissue. The rate of response appears to decrease during the later months of treatment; however, this is due to patients achieving their treatment goals and going into maintenance therapy and off study.
Reductions in excess of 100% are noted in some patients. We have consistently noted that after effective control of lymphedema, the affected extremity can be smaller than the unaffected extremity. This appears to be due to atrophy of the musculature of the affected extremity.
Linear regression analysis was performed to demonstrate that treatment with the ReidSleeve BioCompression/Optiflow system leads to long-term reduction in lymphedema. In this analysis each patient is evaluated over time during treatment. If the treatment is effective and if the effect is maintained, continual reduction in edema would be observed. The graph below shows that many patients have significant improvements during the early phases of treatment (Fig. 2). However, this analysis also demonstrates that there is a consistent improvement in lymphedema with time after initiation of treatment. 50% reduction in lymphedema is seen at approximately 16 weeks. By approximately 60 days some patients had achieved reductions in excess of 90% and by 28 weeks the average reduction was 80%. The response to treatment is highly significant (p<0.001).
During the initial phase some patients had worsening lymphedema. These exacerbations were transient and due to secondary causes common among patients with moderate to severe lymphedema including infections. When treated for the infections, these patients were put back on treatment with compression. By 3 to 4 months after initiation of treatment with the ReidSleeve BioCompression/Optiflow system, marked improvement in lymphedema was observed in nearly all patients.
The combination of the ReidSleeve with the BioCompression/Optiflow system can provide effective therapy for lymphedema. By effectively treating interstitial edema and by avoiding unnecessary stress on the tissues during the plateau phase, tissue repair was enhanced. The changes in skin tone and color became visibly evident. The repair of tissue provided a basis for further improvements in the subsequent weeks and months.
Similar results were observed for patients with lymphedema of the lower extremity. I will address this in the next eNews.
Tony Reid MD Ph.D