The power of compression

Compression is also part of the standard treatment for lymphedema
in Italy. Modern compression products are absolutely crucial to
treatment success, whether following elective knee procedures or
in cases of serious complications. The wide range of applications
was presented by three lymphology experts from Savona, Milan and
Naples.

In his specialized clinic that serves as a referral center for complex
cases, Dr Alberto Macciò, a professional surgeon in lymphology
and phlebology, often receives patients with conditions that are
refractory to treatment or aggravated by complications. For this
reason, he was invited for the second year running to speak to the
audience of professionals at the Lymphology Atelier about treating
serious lymphatic system diseases, such as lymphangitis, involving
the superficial lymphatic network and the major lymphatic vessels,
and lymphatic ulcers.

According to Dr Macciò, an effective therapeutic approach requires
an understanding of an important concept: lymphology deals with
“the immune system’s infrastructure”. If the immunological
function of the lymphatic system is understood, exacerbations can
be treated appropriately and successfully. Drawing from the
numerous cases treated at his clinic, Dr Macciò illustrated the
importance of properly treating wounds, but he also warned
against the frequent, and often excessive, use of antibiotics. Dr
Macciò also highlighted the importance of compression, by
referring to “the power of the bandage”. Dr Macciò found the use
of multilayer compression bandages to be effective, for example
with ulcers, although it is still necessary to ensure a high SSI
(static stiffness index).

Dr Macciò also underscored the importance of an integrated
approach to lymphology, which should not be limited to reducing
volume, but should also consider the immunological and
microenvironmental function of the lymphatic system. Objective
monitoring and structured therapeutic planning are required
between the intensive and the maintenance phases.
Lastly, Dr Macciò’s speech drew attention to the importance of
objective monitoring of volumes using 3D technologies, tools
which are now recognized in international guidelines, enabling
more accurate management of the transition from the intensive
phase to the maintenance phase.

Therapeutic effects of quality compression
Dr Katia Boemia from the Center for the Treatment of Lymphedema
and Lipedema in Naples spoke about compression bandages.
Lymphedema therapist and physiotherapist Dr Boemia presented a
wide range of images to discuss the importance of maintenance
therapy using high-quality flat knit compression garments, such as
VenoTrain curaflow, in the form of stockings, arm sleeves,
leggings, shorts and toe caps). This therapy can only be initiated
once the volume of the affected limb has already been reduced by
70% compared to the contralateral limb, through manual therapy.
Dr Boemia also stressed the importance of good patient
interaction, which has a positive impact on treatment adherence.

Treatment of lymphedema after TKR
Dr Sabrina Brambilla talked about a diagnosis that is frequent in
orthopedic practice, namely lymphedema following total knee
replacement and complex physical decongestive therapy (CDT) in
rehabilitation. As head of the Vascular Surgery Unit of the Zucchi
Clinics and of the Lymphology Service at the “Zucchi Linfedema
Center”, Dr Sabrina Brambilla presented several ongoing studies
on this specific topic. Recent research has shown a 5 to 25%
prevalence of lymphedema in patients who have undergone knee
or hip replacement surgery, particularly patients with previous
vascular or lymphatic conditions. Post-operative edema is a
frequent consequence of surgery, in some cases persisting and
causing joint stiffness, pain or infection, and prolonging the
duration of rehabilitation. As the onset of edema after total knee
replacement (TKR) is not unusual and is in fact foreseeable, it often
evades diagnostic attention. Another negative factor, according to
Dr Sabrina Brambilla, is often the insufficient knowledge about
lymphedema in rehabilitation and orthopedics. As a consequence,
diagnosis is delayed by more than twelve months, on average, as
has been shown in European multicenter studies. When an edema
persists for more than six weeks, it hardens and the outcome of
rehabilitation is generally below the expected standard. Thus, a
lymphological evaluation is advisable. Considered at risk are:
patients with BMI ≥ 30; patients receiving radiation therapy;
patients who have undergone lymph node dissection and patients
with chronic venous insufficiency. Lymphedemas are most
frequently pretibial or popliteal.

Dr Brambilla believes that CDT is the preferred therapy, as it acts
on several aspects of the disease. One randomized study showed
that criteria such as bending angle, perception of pain and
reduction in volume are clear benefits of CDT. A preliminary study
of 24 patients in three groups produced similar results. One study
group was treated with conventional physiotherapy combined with
multilayer compression bandages, one group with conventional
physiotherapy combined with manual lymph drainage (Vodder/
Földi techniques), and the third group was the control. Both the
group with compression bandages and the group that received
massage treatment showed a significant reduction in volume,
unlike the control group. CDT also had a positive impact on
functional recovery: both active and passive joint excursion was
greater than in the control group, especially in the “group with
compression bandaging”. Dr Sabrina Brambilla thus concluded her
presentation by saying that CDT is recommended in addition to
conventional physiotherapy after TKR surgery.
Medical history enthusiasts were also given a little gem to take
home with them from their short stay in Italy: the news that Dr
Alberto Macciò has dedicated an entire room of his Museum of the
History of Medicine in Savona to the “History of Lymphology”.
(Contact us via the storiedellamedicina.com website)

Pictures: Andreas Wetzel, Bauerfeind AG, shutterstock