Methods for evaluation of effectiveness of intermittent pneumatic compression in evacuation of edema fluid from legs with inflammatory changes and ulcers

Objectives. Edema of tissues accompanies leg ulcer. Although it is a positive inherent component of inflammation, intercellular fluid excess may lead to damage of tissue structure as epidermal desquamation, infection, ulcers, and subsequent fibrosis. Evaluation of mobile edema fluid is necessary for ulcer healing.

Aim. To prevent tissue edema detection methods and hints for effective fluid evacuation.

Methods. The following methods were applied in 100 legs with lymphedema, celulitis, and non-healin ulcer: dielectric constans-subepidermal water, bioimpedance-electric conductivity depending on extracellular water condact, durometry-skin stiffness, deep tonometry-subcutaneous tissue stiffness, fluid mobilization force meter, visualisation by indocyanine green fluorescence, lymphoscintigraphy, tissue spaces xray graphy, ultrasonography (US),and MRI. All these methods provide data on edema fluid volume necessary for evaluation of compression therapy.

Results (means). Subepidermal water >40%, bioimpedance Ldex >10, skin stiffness >0.8 Newtons, deep tonometry >1 kg/sq.cm, fluid mobilization >50mmHg, ICG fluorescence level 40-60%, lymphoscintigraphy- subdermal accumulation, US- fluid "lakes" and MRI honey-comb image. Images of each recording will be presented. After standard 45 min 120 mmHg compression subepidermal water decreased by ca. 10%, skin stiffness by 20%, deep tonometry by 40%, and ICG image intensity by 10%.

Conclusions. Compression therapy parameters to effectively decrease edema and inflammation and facilite healing of ulcers should be based on edema fluid physical measurements.