Quantitative Evaluation of Leg Soft Tissue Volume Increase- fluid and Cell Proliferation – Measurement Before and After Compression
Background: Chronic limb edema is caused by retention of the capillary filtrate, connective tissue growth and matrix deposition. The increase of tissue mas is usually not being taken into consideration. Patients with limb edema are aware only of fluid problems, the tissue changes problem is not raised by the treating personnel. At present, diagnostic methods are available to recognize and quantitate both fluid and tissue components of the edematous limb. This is especially important for evaluation of compression results, as the edema fluid volume becomes reduced, whereas excess tissue (cells and matrix) remains increased.
Aim: To prove the efficacy of modern tissue edema fluid detection methods and hints for effective fluid evacuation as well as measurement of the volume of increased retained tissue mass.
Methods: The following methods were applied in 100 legs with lymphedema: A. for tissue fluid; dielectric constans- subepidermal water, bioimpedance-electric conductivity depending on extracellular water contact, durometry - skin stiffness, deep tonometry- subcutaneous tissue stiffness, fluid mobilization force meter, visualization by indocyanine green fluorescence, lymphoscintigraphy, and for solid tissue: tissue spaces Xray graphy, ultrasonography (US) and MRI. All these methods provide data on edema fluid volume necessary for evaluation of the compression procedures and density of solid elements.
Results: Edema parameters for fluid were: subepidermal water > 40%, bioimpedance Ldex >10, skin stiffness > 0.8 Newtons, deep tonometry > 1kg/sq.cm, fluid mobilization > 50mmHg, ICG fluorescence level- 40-60%, lymphoscintigraphy- subdermal accumulation, and for solid tissue US-thickness (skin 5%, subcutaneous tissue 20% and MRI honey-comb image density (5-25%). Pre- and post- compression numerical data and images will be presented.
Conclusions: Compression therapy to decrease edema should be applied and evaluated basing on edema fluid physical parameters. Simple volume measurements are not anymore tenable. The tissue overgrowth volume should also be quantitated.
