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Arch Surg. 1998 Apr;133(4):452-8.

Effective treatment of lymphedema of the extremities.

Author information

1
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.

Abstract

OBJECTIVE:

To define the immediate and long-term volumetric reduction following complete decongestive physiotherapy (CDP) for lymphedema.

DESIGN:

Prospective study of consecutively treated patients.

SETTING:

Freestanding outpatient referral centers.

PATIENTS:

Two hundred ninety-nine patients referred for evaluation of lymphedema of the upper (2% primary, 98% secondary) or lower (61.3% primary, 38.7% secondary) extremities were treated with CDP for an average duration of 15.7 days. Lymphedema reduction was measured following completion of treatment and at 6- and 12-month follow-up visits.

INTERVENTION:

Complete decongestive physiotherapy is a 2-phase noninvasive therapeutic regimen. The first phase consists of manual lymphatic massage, multilayered inelastic compression bandaging, remedial exercises, and meticulous skin care. Phase 2 focuses on self-care by means of daytime elastic sleeve or stocking compression, nocturnal wrapping, and continued exercises.

MAIN OUTCOME MEASURES:

Average limb volumes in milliliters were calculated prior to treatment, at the end of phase 1, and at 6- to 12-month intervals during phase 2 to assess percent volume reduction.

RESULTS:

Lymphedema reduction averaged 59.1% after upper-extremity CDP and 67.7% after lower-extremity treatment. With an average follow-up of 9 months, this improvement was maintained in compliant patients (86%) at 90% of the initial reduction for upper extremities and lower extremities. Noncompliant patients lost a part (33%) of their initial reduction. The incidence of infections decreased from 1.10 infections per patient per year to 0.65 infections per patient per year after a complete course of CDP.

CONCLUSIONS:

Complete decongestive physiotherapy is a highly effective treatment for both primary and secondary lymphedema. The initial reductions in volume achieved are maintained in the majority of the treated patients. These patients typically report a significant recovery from their previous cosmetic and functional impairments, and also from the psychosocial limitations they experienced from a physical stigma they felt was often trivialized by the medical and payor communities.

PMID:
9565129
[Indexed for MEDLINE]

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