Is intermittent pneumatic massage effective in the evacuation of fluid in leg edema caused by lymphatic obstruction and non-healing wounds? ICG visualization and semiquantitative analysis

Introduction. Intermittent pneumatic compression (IPC) is the commonly used modality for therapy of limb lymphedema of different etiology. What seems to be necessary for validation of the effect of the compression procedure is imaging of the mobilized moving edema fluid. Picture of edema fluid flow would allow the therapist to use force adjusted to the tissue volume and stiffness differing in various limb regions and identify sites of abundant accumulation of fluid requiring more compression. Aim. The purpose of the present study was to visualize and semiquantitative analysis (fluorescent intensity measurement) of tissue edema fluid flow during IPC along the limb. Material and methods. Twenty patients with post-surgical (after hysterectomy and radiotherapy in uterine cancer and mastectomy in breast cancer) lymphedema of lower and upper limbs, ten patients with postdermatitis leg edema, and 5 cases with venous ulcers were investigated. ICG dye (0.25 ml of 0.5% solution) was injected between the toes or fingers. Intermittent pneumatic compression (8 chamber sleeve, each chamber inflated to 50, 80, 100, and 120 mmHg for 50 sec) was used. Visualization was done before and after 30 min of IPC. Resalts. The following observations were obtained: (1) the possibility of real-time observation of edema fluid movement during IPC and measure the changes of fluorescent intensity along the entire limb (2) the threshold pressures necessary to move edema fluid to be over 60-80 mm Hg in the compression device (3) inefficacy of compression in some cases despite applying high compression force and (4) accumulation of fluid around but not in ulcer bed. Conclusions. These observations point to the need of ICG lymphangiography before compression therapy in each patient. The images observed during the compression procedure give an insight into the distribution of edema fluid, sites of its accumulation, the outflow pathways of the edema fluid under compression, and the efficacy of applied external force on fluid mobilization.