Abstracts LymphForsch 1/2010

Liposuction for patients with lipedema insured by the German social health insurance system - Pro and contra with regard to prioritization and socioeconomic conditions-

W. Schmeller, I. Meier-Vollrath, LymphForsch 2010;14(1):9-13 

Summary
In the guidelines for lipedema treatment, in addition to decongestive therapy, surgical therapy (liposuction) is advised as a standard treatment. However, in most cases the German social health insurance system refuses to pay for the costs of treatment. While primarily medical arguments are cited, it is clear that this refusal is chiefly due to the socioeconomic restrictions in the German social health insurance system. At present objective criteria in the form of prioritization are being tested for evaluation and to create a ranking list for the validity of treatment. For liposuction it is not yet clear whether in addition to an improvement in the quality of life, a reduction in lifetime treatment costs can be achieved. 

Keywords: liposuction, lipedema, social health insurance system, prioritization 
E-mail: ws@hanse-klinik.com

Intertester variability of “home-made”-arm volumeters for determining arm volume: A prospective trial

U. Seifart, E. Kettner, U. Albert, LymphForsch 2010;14(1):14-19

Summary
Secondary lymphedema is one of the most frequent long-term side effects among all breast cancer patients after standard axillary surgery or radiation therapy. The diagnosis of lymphedema is largely based upon the history, physical examination and measurements of limb circumference. Water displacement is the current gold standard. This study was performed to evaluate the variability between measurements of limb circumference and water displacement. To this end, the two measurement methods were carried out in ten healthy volunteers by ten independent investigators (n = 10). An inexpensive “home-made” volumeter was used to determine volume. In this prospective study no differences were observed in the results obtained from the two methods. 

Keywords: lymphedema, measurements of limb circumference, water displacement, intertester variability 
E-mail: ulf.seifart@drv-hessen.de

Indirect depot tendon lymphangiography (DTL): A radiological method for proving the effect of manual lymph drainage (MLD) in horses

T. Helling, A. Roetting, P. Stadler, D. Berens v. Rautenfeld LymphForsch 2010;14(1):20-23
  
Summary
The goal of this study was to evaluate the effect of manual lymph drainage (mLD) on the lymphatic transport from clinically healthy digital flexor tendons of horses. Indirect depot tendon lymphangiography (DTL) was performed on 12 pairs of limbs of 8 horses. Immediately after injection of the radiographic contrast medium into the tendon, it was possible to identify the deep lymphatic collectors. The contrast medium used drained from the lymphatic collectors significantly faster (by a factor of 1.7) after MLD (p = 0.012). 

Keywords: indirect depot tendon lymphangiography (DTL), manual lymph drainage (MLD), lymphatic vessels, flexor tendons 
E-mail: Tanja-Helling@web.de

Dystopic calcifications - A complication associated with lower leg ulcers

B. Heinig , U. Wollina, LymphForsch 2010;14(1):24-30
   
Summary
Dystopic calcifications constitute a possible cause of non-healing lower leg ulcers. Dystrophic calcifications as a special type of dystopic calcifications can occur in patients with chronic venous insufficiency. This combination is associated with long-term trophic disturbances of the tissue in the cutis and subcutis down to the fascia, that means the tissue between skin and fascia. Currently, deep ulcer-shaving therapy following meshgraft transplantation provides the best healing conditions when good ulcer care, including debridement, does not provide relief. adjuvant physical therapy applications, in particular, decongestive therapy and kinesiotherapy, should always be included as a component of the therapy concept. 

Keywords: dystopic calcification, chronic venous insufficiency, leg ulcer 
E-mail: heinig-bi@khdf.de

Study on the quality of out-patient care of edema patients in Germany (2007)

U. Herpertz, B. Netopil, LymphForsch 2010;14(1):31-34
 
Summary
In a study, 300 patients under treatment at the oncological and cardiological departments of a rehabilitation center were examined by experienced lymphologists with regard to quality of their previous out-patient edema therapy. The results show considerable deficits in the treatment of patients with edema who need physical therapy for edema. 

Keywords: quality, physical edema therapy, manual lymph drainage, compression stockings 
E-mail: dr.ulrich@herpertz.net

Successful complete physical decongestive therapy for a patient with elephantiasic lipophlebolymphedema accompanied by decubitus at an outpatient lymphedema treatment center

K. Schiller, C. Bromberger, LymphForsch 2010;14(1):35-38
  
Summary
Elephantiasic lipophlebolymphedema complicated by decubitus and morbid obesity was successfully decongested through complete physical decongestive therapy and wound care at our out-patient treatment center for lymphedema management in close cooperation with the patient„s physician. after twelve months of intensive treatment, the patients decubitus was healed and both feet and lower legs decongested. Following decongestive therapy, the patient was fitted with flat-knitted knee-high compression stockings. after a second decongestive phase, an additional compression garment (capri pants) was fitted for treatment of the thighs and lower body. after nine months, an apron of fat weighing 12 kg was removed in reduction plastic surgery. 

Keywords: elephantiasic lipophlebolymphedema, morbid obesity, decubitus 
E-mail: schiller-physio@anpa.de