LAUSR

BACKGROUND Evaluation of intermittent pneumatic compression (IPC) in lymphedema is classically based on measurements of circumferences and volume of the edematous limb. However, although important, it provides only a general information without insight into what proceeds under the skin with respect to hydromechanical and structural changes. AIM AND METHODS We present the multimodal evaluation of the effectiveness of IPC device in limb edema by measuring tissue stiffness, fluid pressure, and flow volume, and lymphoscintigraphic and near-infrared fluorescence (NIRF) indocyanine green (ICG) lymphography imaging of edema fluid movement, before and after one 45-60 minute compression cycle in over 50 patients with lymphedema stage II and III. RESULTS (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, subcutaneous tissue (deep tonometry) was observed at all limb levels. (4) 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. (5) Imaging tissue (edema) fluid flow pathways on lymphoscintigram and real-time flow on NIRF ICG video could be observed and were evaluated semiquantitatively. CONCLUSIONS 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.