Effectiveness of lymphedema management and physiological mechanisms.

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【PURPOSE】Multi-layer inelastic lymphedema bandaging (MLLB) or hosiery (elastic stockings) combined with exercises, skin care, and manual lymphatic drainage therapy is recommended as an intensive phase of treatment for lymphedema patients. Recently, anastomosis of lymph vessels to the venous system may be attempted in patients with lymphedema, and produces better results at earlier stages of lymphedema. The purpose of this study is to compare the effect of MLLB and anastomosis of lymph vessels to the venous system.【METHODS】A retrospective case-control study was undertaken in the setting of the lymphedema Clinic, the Keio University Hospital, Tokyo. The women with secondary lymphedema of the lower limbs, caused by cancer of the uterine cervix and body, and ovarian cancer were enrolled. The interventions consisted of MLLB alone combined with exercises, skin care, and manual lymphatic drainage therapy (MLLB group), MLLB and hosiery combined with those (MLLB and hosiery group), and anastomo … More sis of lymph vessels to the venous system (operation group). Operation group followed by MLLB after receiving operation. The main outcome measure was the reduction in circumference of lower limb at AK10 (10cm above the superior pole of the patella), BK10 (10cm below the inferior pole of the patella), BK20 (20cm below the inferior pole of the patella), and ANKLE (just above the medial and lateral malleolus).【RESULTS】The circumference of lower limb decreased significantly in MLLB group (N=13), MLLB and hosiery group (N=15), and operation group (N=17). The circumference at AK10, BK10, BK20, and ANKLE in the one month decreased significantly in MLLB group and operation group, whilst the circumference at ANKLE decreased significantly in MLLB and hosiery group (paired t-test). Concerning the comparison among three groups, the circumference at AK20, BK20, and ANKLE decreased in MLLB more than operation group, and the circumference at BK20, and ANKLE decreased in operation group more than MLLB and hosiery group (two-way ANOVA and Fisher'sPLSD test).【CONCLUSIONS】MLLB alone, MLLB and hosiery, and anastomosis of lymph vessels to the venous system followed by MLLB as an initial phase of treatment for lymphedema patients obtained the sustained limb volume reduction than hosiery alone. Although lymphatic grafting requires microsurgical techniques, it was suggested to show promising results in carefully selected patients. Less