Marzanna T. Zaleska, MD1,2 and Waldemar L. Olszewski, MD, PhD2. Lymphatic Research Biology 2018

Main findings

• This study presents the multimodal evaluation of the effectiveness of pneumatic compression device in limb oedema by measuring tissue stiffness, fluid pressure, and flow volume, and lymphoscintigraphic and NIRF ICG lymphography imaging of oedema fluid movement, before and after one 45–60 minute compression cycle.
• The IPC was applied in each patient for 1 hour. The sleeve inflation pressure at foot level was 120mmHg, gradually decreasing in the groin by 20%. The inflation time was 5 seconds / chamber amounting to 40 seconds for the whole sleeve. It was followed by 5 seconds deflation. The measurements were taken before and after 1 hour use of IPC.
• The sleeve was composed of eight segments, each 9cm long, sequentially inflated chambers. It embraced the whole limb up to the inguinal crease.
• This study was done to evaluate the changes in limb volume, tissue stiffness, and tissue fluid concentration, as well as force necessary for mobilization of fluid and imaging its movement during 1 hour IPC in the same patient. There was
• There was an expected decrease of circumference and volume of lower parts of calf and thigh. However, what concerns tissues, diverse events arising from applied pressure were observed. These effects were as follows: (1) tissue fluid pressures were lower than those applied by IPC device, (2) the higher the applied compression force, the larger the flow volume, (3) skin stiffness (superficial tonometry) decreased mainly in the calf, whereas, that of subcutaneous tissue (deep tonometry) decreased at all limb levels, skin water concentration (dielectric constant) was only insignificantly decreased, but subcutaneous extracellular water (bioimpedance Ldex index, fluid movement force test) was effectively moved away to limb proximal regions, imaging tissue (edema) fluid flow pathways on lymphoscintigrams and the real-time flow on NIRF ICG video could be observed and evaluated semi quantitatively. A number of their observations need wider explanation. The decrease in circumference was most notable above the ankle and mid-calf. They found that measuring circumference changes at various levels of the limb better illustrates the dynamics of edema fluid translocation during IPC than calculation or direct measuring of the total volume, since there is uneven translocation of fluid in the limb. Fluid moved on lymphograms to the popliteal fossa containing loose connective tissue, where it cannot be accurately measured, and to the groin and buttock regions with lax skin and fat layer, where volume measurements method are difficult to be applied.
• This is an indicator that adjustment of compression parameters to tissue stiffness, fluid accumulation volumes, and fluid movement ability (hydraulic conductivity of tissues) at various limb levels is indispensable for effective therapy. Redesigning of compression devices will be needed to enable applying differentiated compression pressures and prolonged timings at various limb levels.