Bauerfeind pre-symposium at the IUP World Congress Lymphedema – a multi-factor ailment
During the 18th World Congress of the International Union of Phlebology (IUP) in Melbourne (Australia) international experts had the opportunity to discuss causes, treatment options, secondary diseases, and effective follow-up measures for lymphedema. Bauerfeind life sums up the most important findings.
Compression for positive effects on the cardiovascular system
“Lymphedema is a multi-factor condition,” said Dr. Gyözö Szolnoky from Szeged University in Hungary when he introduced the first lecture. He went on to give a comprehensive overview on the principles of lymphedema. Dr. Szolnoky is currently performing research for a study about the effects that compression garments have on the cardiovascular system. “We are examining whether measurable positive effects are achieved for the function of the left ventricle of the heart when knee-length sports socks are worn by healthy individuals or when medical compression pantyhose are worn by lymphedema and lipedema patients,” explained the winner of the 2015 Bauerfeind Phlebology Award. Initial results show that compression has positive effects on left ventricular (LV) rotation in lipedema patients. In otherwise healthy persons with lymphedema, compression at least does not hinder LV rotation.
Genetics of primary lymphedema
“The term primary lymphedema refers to a group of rare conditions but the exact prevalence is not known. Recent genetic research is leading to a better understanding of these conditions”, said Prof. Vaughan Keeley, a lymphedema specialist from Derby (UK). The abnormalities of the lymphatic system, which cause primary lymphedema, include hypoplasia of the vessels, maldevelopment of the lymphatic valves and a failure of the initial lymphatics to take up interstitial fluid. It can be present from birth but more commonly develops later on in childhood and adulthood. In some types there are other associated features e.g. in primary lymphedema due to a mutation of the GATA2 gene, there may be an increased risk of acute leukaemia. Lymphatic abnormalities may also occur in overgrowth syndromes e.g. in PIK3CA related overgrowth spectrum (PROS). “It is hoped that a better understanding of the genetic causes of these conditions may lead to improved treatments in the future”, explained Prof. Keeley.
Encouraging patients’ personal management
Prof. Christine Moffatt’s lecture focused on personal management of lymphedema and venous ulcer patients. The expert for nursing research from Nottingham University (UK) recommends that doctors should develop holistic treatment approaches for their patients by taking physical , mental , social , and cultural factors of the condition into account. The patient should be involved in the treatment by offering real choices in terms of treatment options as well as suitable training. “You even have to respect a patient’s right to reject a certain therapy,” said Prof. Moffatt. She considers compression therapy to be part of the basic treatment. Concerns about circulation problems caused by compression are rather common. This fear is not justified, however, and controlled compression is considered to be safe. She went on to explain that it was not always necessary to remove compression equipment in every case of pain, as patients tended to tolerate compression if it reduced their symptoms. She further mentioned that venous ulceration also tends to heal better under compression
Dr. Misbah Shireen Ahmed from the clinic and polyclinic for skin diseases in Greifswald (Germany) spoke about extreme lymphedema of the lower extremities. “We have recently observed a disproportionately large share of patients with very advanced cases of lymphedema,” said the physician. This could be explained by the fact that there is an increasing number of people who are significantly overweight. Owing to low self-esteem, these patients frequently do not come to the clinic before they reach a severe stage of the illness. At this point they are already experiencing various types of complications that require expensive multidisciplinary treatment. “Despite the fact that some of my peers have considered amputation to be the only solution in severe cases, we can achieve good results with a combination of surgical and non-surgical treatment ,” the physician was pleased to say. In detail , this comprises surgical debridement of the wound, negative-pressure wound therapy and skin transplants as well as cold, antiseptic dressings, class 3 corticosteroids and salicylic acid (including in the form of creams), possibly systemic treatment using antibiotics and thrombosis prophylaxis and finally gymnastics, manual lymphatic drainage, intermittent pneumatic compression, and compression supports and stockings. “It’s not ‘just’ lymphedema,” she appealed to the audience. “It is a complex condition that often also requires psychological support.”
Methods for treatment and follow-up monitoring
Dr. Hans-Jürgen Thomä, of the Phlebology Business Development division at Bauerfeind AG (Germany) spoke about the options of digital treatment and follow-up monitoring compared to water plethysmography. Measuring techniques for determining leg volume are generally used in routine clinical work in order to objectify treatment progress, and they are also often required for clinical studies. Water plethysmography is based on the principle of water displacement. However, it is a relatively time-consuming measuring technique with poor reproducibility. The Bodytronic 600 digital measurement system by Bauerfeind provides for a grid of light beams that is projected onto the body and digitally captured. This allows for an exact 3D image of the affected body part to be generated.
“A study has shown that both methods produce similar results,” Dr. Thomä explained. “However, water plethysmography is limited to the calf, while Bodytronic 600 is suitable for measuring lower and upper legs as well as the pant area. Water plethysmography is also difficult to handle and rather error-prone.” Bodytronic 600 is five times more reliable when it comes to reproducibility.
Images: Larry Pitt
Bauerfeind conducted a pre-symposium on the treatment of lymphedema during the 18th World Congress of the International Union of Phlebology (IUP) in Melbourne, Australia.
- Gyözö Szolnoky is currently conducting research for a study about the effects that compression garments have on the cardiovascular system.
- Christine Moffatt’s lecture focused on self-management approaches for lymphedema and venous ulcer patients.
- Misbah Shireen Ahmed reported on the good results achieved with a combination of surgical and non-surgical treatments for severe cases of lymphedema.