Tissue Structure and Edema Fluid Events During Treatment of Lymphedema of Limbs with a Manual Pressure-Calibrated Device, Linforoll

Marzanna T. Zaleska, PhD, and Waldemar L. Olszewski, MD, PhD. Lymphatic Research and Biology 2019

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Tissue Structure and Edema Fluid Events During Treatment of Lymphedema of Limbs with a Manual Pressure-Calibrated Device, Linforoll

Marzanna T. Zaleska, PhD, and Waldemar L. Olszewski, MD, PhD. Lymphatic Research and Biology 2019

Objectives: Linforoll is a device composed of handpiece with roller and pressure sensor connected wireless to the computer displaying the pressure curve of the applied force. In a previous study, we proved it to regulate the applied force according to the hydromechanic conditions of the massaged tissues. Standardization of massage based on applied force was repeatable in the same patient; it decreased limb volume and provided evident increase in tissue elasticity.

Aim: In this study, we measured additional parameters useful for the understanding of tissue and fluid events and approval of the device for general practice. These were skin stiffness, subcutaneous tissue stiffness independent of skin, skin water concentration, changes in skin temperature, skin capillary blood flow, subcutaneous tissue fluid pressure, volume of the moved edema fluid, and visualization of movement on indocyanine green (ICG) lymphography. Measurements were done before and during the massage.

Results: The data were obtained from a group of 20 patients with obstructive lymphedema of lower limbs during the Linforoll massage. There was a lack of significant changes in skin stiffness, skin water concentration, skin surface temperature, and capillary blood flow, but evident increase in the subcutaneous tissue elasticity (tonometry) and lymphography-shown flow of the edema fluid.

Conclusions: The skin tissue hydromechanic parameters remained normal proving lack of destructive changes under high massaging pressures. The obtained data evidently show that not the skin but the subcutis accumulated oedema fluid that can successfully be moved proximally under pressures of 80–120mmHg.

Main findings

  • The basic disadvantage of the routine manual technique is lack of knowledge of the level of force applied to tissues and the generated solid tissue/oedema fluid events under the skin.
  • This paper follows on from a publication in 2016. Olszewski WL, Zaleska M, Michelin S. A new method for treatment of lymphedema of limbs: Standardized manual massage with a new device Linforoll in conservative and surgical therapy protocols. Lymphat Res Biol 2016; 14: 226–232.
  • In this study, they measured more parameters useful for the understanding of tissue and fluid events and useful for approval of the device for general practice. They are stiffness of skin and subcutaneous tissue, skin water concentration, changes in skin temperature, skin capillary blood flow, subcutaneous tissue fluid pressure, volume of the moved subcutaneous fluid, and flow visualization on indocyanine green (ICG) lymphography during massage. These parameters were obtained during Linforoll massage in a group of 20 patients with obstructive lymphedema of lower limbs.
  • The Linforoll technique utilised the anterior aspect of the calf which was massaged 20-times with a speed 6/min at a pressure of 80–120mmHg. The direction of rolling was based on the anatomical positioning of peripheral lymphatics running toward the knee. The rolling force was hand-adjusted between 80 and 120mmHg, depending on the stiffness of tissues along the Linforoll truck. The resistance to rolling is felt during the procedure depending on the local tissue hardness and fluid accumulation. Applying different force at various limb levels enables fluid movement from the resistant with less force used at soft regions.
  • The authors concluded that the obtained data evidently shows that not the skin but the subcutis accumulated oedema fluid that can successfully be moved proximally under the pressures of 80–120mmHg. This indicates that high rolling pressures are necessary to move fluid and are not harmful to the tissues.