Decongestive lymphatic therapy in postfilarial lymphedema: A prospective study

Abstract

Context: In a filariasis endemic country like India, the need for an effective and consistent treatment for filarial lymphedema has long been recognized. In this study, we set out to evaluate decongestive lymphatic therapy (DLT) for postfilarial lymphedema. Aims: The aims of this study are to determine the efficacy of DLT in the management of postfilarial lymphedema of extremities. Settings and Design: This is one prospective study from April 1, 2010, to March 30, 2011 included twenty patients with the diagnosis of lymphedema of the extremities. After the Institutional Review Board approval, consent was taken. Subjects and Methods: Patients with unilateral postfilarial lymphedema were included in the study. Exclusion Criteria: (1) Other forms of lymphedema, (2) Clinical evidence of local infection, (3) Severe cardiac disease, (4) Uncontrolled hypertension, (5) Malignancy. The clinical profile of the patient was recorded and was noted. Limb circumferences were measured at axial intervals of 10 cm for the entire limb length. Each segment's volume was calculated with the truncated cone formula H × (C2 + Cc + c2)/12 Π, H = height, C = circumference at the top of the cone, c = circumference at the base of the cone. Total limb volume was acquired by adding the segments. Patients were subjected to daily DLT which included manual lymphatic drainage, low-stretch compression bandaging, and skin care and exercises and volume reduction measured. The patients were followed up for 1 year. Statistical Analysis Used: Spearman's rank correlation coefficient, one sample t-test, Mann–Whitney U-test. Results: The mean reduction in the volume of the affected limb was 63.12% with standard deviation of 11.38 and P < 0.001. Long-term therapeutic benefits were maintained through self-massage, self-bandaging, exercise, and consistent use of compressive garments. The average volume of the affected limb at presentation was 10067.45 ml ± 3768.42. After DLT, the average volume was 7860.4 ml ± 2617.36. The average volume after 1-year follow-up was 8109.3 ml ± 2438.4. There was no correlation between the severity of pretreatment limb volume and the extent of reduction after DLT. No complications were seen during the course of the study. Conclusions: DLT is an effective and safe modality for the treatment of lymphedema of the extremities. It has wide applicability, especially in postfilarial lymphedema.

Keywords

• Compression therapy
• decongestive lymphatic therapy
• lymphatic therapy
• postfilarial lymphedema