Today's Wound Clinic - Winter 2008 - (Page 42) intech TABLE 2. Recommended Pump Types and Treatment Parameters for Lymphedema Recommendations are a compilation of expert opinion, author’s experience and review of evidence Treatment times Treatment frequency Pump type Compression levels Treatment duration 30 minutes 1 to 2 times per day type III intermittent sequential pump with multiple ports for individual chambers/segments and manual controls. 30–35 mm Hg As needed to gain initial control or maintain limb volume reduction TABLE 3. Selected treatment parameters utilized in arm lymphedema studies: Dubois Pressure levels Pump type Treatment length 40 mm Hg Sequential 6 hours over 5 days Szuba et al10 30–40 mm Hg Sequential 30 min/day for 10 days Zelikovski et al12 100–150 mm Hg Sequential 2–3 hours, 3 times for 3 days ed by the Lympha-Press™ device, (Mego Afek, Kibbutz Afek, Israel) are typically recommended. Sequential filling of multiple compression chambers is thought to more efficiently move lymph proximally toward the heart. Recommended treatment parameters are listed in Table II. A recent review of the literature by Moseley et al,8 indicated that evidence exists to support the use of sequential pneumatic compression pump therapy in the treatment of limb swelling due to lymphedema. Five studies9–13 were systematically reviewed in this work. Of these two studies,9,12 indicated that limb volume could be reduced with pump therapy alone while the other three studies10–13 demonstrated better limb volume reduction when pneumatic compression therapy was combined with other treatment modalities. In one small study, individuals treated with an intensive regimen of sequential compression pump therapy exhibited a more rapid reduction of limb volume as compared to individuals who 42 Winter 2008 Today’s Wound Clinic received manual lymphatic drainage and compression pump therapy.8 The compression pump used in this study was a sophisticated, intermittent sequential, multichambered device designed specifically for lymphedema management. Lymphedema therapists report excellent benefits with this device. However, it is costly compared to compression pumps and has fewer chambers and is not typically covered by insurance. In another study, compression pump therapy plus a complex regimen of manual lymphatic drainage, compression bandaging, skin care, and exercise also produced a greater reduction of limb volume when compared to individuals receiving complex therapies alone.9 A study by Zelikovski et al,12 also found positive benefits associated with pneumatic compression pump therapy. This study demonstrated that compression pump therapy alone was effective in reducing arm lymphedema. It should be noted that this study employed high treatment pressures (>100 mm Hg) which are thought to produce scarring and damage of the fragile superficial lymphatics. Interestingly, a separate research group also found long-term benefits associated with high pressure sequential pump therapy.14 High pressure sequential pump therapy in combination with compression stockings was associated with long-term maintenance of reduced limb girth in 90% of patients. In comparison to the above studies, Dini et al,15 found no difference in limb volumes of patients with post-mastectomy lymphedema who either received pneumatic compression therapy or no treatment. Taken together, the above studies indicate that pneumatic compression therapy is effective in decreasing lymphedema. Some evidence also suggests that multi-compartment devices (10 chambers) are more effective in treating lymphedema than single or three compartment pneumatic compression devices.16 Pump type and treatment parameters used in several of these studies are provided in Table III. These parameters show some similarity to those provided by the author in Table II. A number of studies also have examined the effects of pneumatic compression therapy on wound healing and limb volume reduction in individuals with CVI. The results of these studies have been mixed. Berliner et al,17 reviewed eight studies, three of which showed that compression pumps could alleviate symptoms of CVI and assist with the healing of long-standing chronic ulcerations. However, results from a study by Rowland18 demonstrated that time to volume reduction and rates of healing were similar when intermittent pneumatic compression pump therapy was compared to compression bandaging. High pressure, intermittent pneumatic compression therapy also is being adopted for the treatment of ischemic limb tissue due to peripheral arterial disease. Several pneumatic compression technologies exist that appear to enhance vascular
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