Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging

Catalina Lopera, Peter R Worsley, Dan L Bader, and Deborah Fenlon. LYMPHATIC RESEARCH AND BIOLOGY Volume 00, Number 00, 2017

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Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging

Catalina Lopera, Peter R Worsley, Dan L Bader, and Deborah Fenlon. LYMPHATIC RESEARCH AND BIOLOGY Volume 00, Number 00, 2017

Background: Lymphedema is a chronic peripheral swelling caused by a dysfunction of the lymphatic system, leading to discomfort and loss of upper limb movement. Therapies to treat or manage this swelling have limited evidence, partly because of a paucity in objective lymphatic measures. This study explored the role of nearinfrared (NIR) imaging in evaluating interventions.

Methods: Nine healthy volunteers underwent NIR fluoroscopy using a microdose (50lL, 0.05% w/v) of indocyanine green to quantify lymphatic nalysed before and after a 15-minute period of manual lymph drainage followed by compression garment (CG) therapy for a 10-minute period. Images were taken at the forearm and elbow after each intervention. Lymphatic function was defined by the number, size, displacement, and speed of lymph packets. The lymph parameters were nalysed to assess the effects of the interventions compared with basal values.

Results: Baseline (BL) parameters of lymph function revealed high variability in the number, size, and speed of packets between individuals. Despite this variance, both interventions showed statistically significant improvement (p<0.05) in displacement and speed at the forearm compared with BL. The velocity of transient lymph packets increased from a median of 6.7mm/s at BL to 13.3mm/s after manual lymphatic drainage (MLD) and 10.5mm/s after CG.

Conclusion: Lymphatic activity increased significantly after MLD, with relative increases being maintained after a short time period of CG application. NIR fluoroscopy has the potential to both monitor lymph pathology and provide robust parameters in the assessment of interventions

Main findings

  • The number of participants in the present cohort study limits the generalizability of the results.
  • MLD was implemented in the right upper limb for 15 minutes, after the Vodder technique.
  • A Juzo class 2 compression arm sleeve was used in the range of 23–32mmHg.
  • The results indicated that MLD had a significant effect on lymph activity, with increases in both speed and displacement of transient packets at the forearm.
  • However, the effects of MLD may not be as pronouced in lymphedema patients, with their tortuous network of capillaries and reduced number of functional lymph vessels,28 increasing dermal back flow and extravascular lymphatic fluid leakage.
  • It has been suggested that for both healthy individuals or lymphedema patients with incipient symptoms, the superficial lymphatics may play a greater role in lymph drainage than deep lymphatic vessels.
  • The study quantitatively evaluated lymphatic functional behavior after a short period of MLD and CG interventions using NIR fluoroscopy. There was an increase in lymphatic activity in the majority of the participants, with a statistically significant improvement in transient lymph velocity and displacement. NIR fluoroscopy has the potential to provide an insight for investigating who will respond to lymphedema treatment or measure whether contractile function is enhanced by the techniques used to manage this complication.