Abstracts LymphForsch 1/2015

How long do patients with lipedema benefit from liposuction? A follow-up study performed an average of 4 and 8 years after surgery

A. Baumgartner, M. Hüppe, W. Schmeller
LymphForsch 2015; 19(1):8-14

Summary
A single-center study with a mail questionnaire – often in combination with clinical controls– was conducted in 85 patients with lipedema an average period of 4 and 8 year safter liposuction was performed. After 4 years there was consistent improvement of spontaneous pain, tenderness, edema, hematoma and restriction of movement; the same was true for a self-assessment concerning cosmetic appearance, quality of life and general impairment. The reduction in conservative treatment (decongestive therapy, compression garments) required established 4 years after surgery still was maintained 8 years after surgery. These results demonstrate the long-term positive effects of liposuction in patients with lipedema.

Keywords: lipedema, liposuction, improvement of symptoms, long-term follow-up

Indocyanine green fluorescence lymphography in everyday Practice

F.J.Schingale
LymphForsch 2015; 19(1):15-18

Summary
The dye indocyanine green offers new opportunities for the investigation, diagnosis and treatment of lymphedema. This fluorescent dye is detected by a special infrared camera, which now enables us to discover the sentinel lymph nodes, develop new surgical techniques, and identify the effectiveness of old and new methods of treatment and possibly gain new anatomical insights.

Keywords: indocyanine green (ICG), photodynamic eye (PDE), fluorescence lymphography, anatomy of the lymphatics , function of lymphatics, monitoring and improvement of lymphedema treatment

Clinical aspects and treatment of papillomatosis cutis Lymphostatica

V. Stadie
LymphForsch 2015; 19(1):19-23

Summary
Papillomatosis cutis lymphostatica is a rare, chronic and progressive cutaneous complication of chronic or latent lymphedema that must be clinically diagnosed. Four clinical types can be distinguished. Treatment primarily entails complex decongestive therapy to improve congestion, although this rarely enables papillomatosis cutis lymphostatica to recede completely. Secondary complications of papillomatosis cutis lymphostatica can frequently be resolved by surgical treatment.

Keywords: papillomatosis cutis lymphostatica, clinical varieties, surgical treatment

Prophylactic use of manual lymph drainage after breast cancer surgery during immediate postoperative periods: Initial results of the Böblingen study

M. Hörner
LymphForsch 2015; 19(1):24-27

Summary
We report on observations after breast cancer surgery and lymph node dissection. Two groups of patients with the primary diagnosis of breast cancer in 2011 and 2013 underwent postoperative treatment with manual lymph drainage (MLD) and surgery-adapted compression bandaging. These two groups were compared to a reference group from 2008 that was treated with physical therapy and surgery-adapted compression bandaging. We compared these groups with respect to the incidence of lymphedema in the arm and breast. Owing to the subsequent breast cancer therapies such as radiation or chemotherapy that may also damage the lymphatics, we were unable to observe an improved preventive effect with MLD as compared to physical therapy. However, the general treatment guidelines and the positive effects of MLD on our patients‘ quality of life during their stay at our hospital confirm its use.

Keywords: breast cancer, postoperative lymph drainage, physical therapy, incidence of lymphedema

The role of manual lymph drainage in wound treatment

H. Cornelsen
LymphForsch 2015; 19(1):28-32

Summary
The effects of manual lymph drainage (MLD) and decongestive compression therapy for managing lymphedema have been proven for years and are undisputed today. Knowledge about the anatomy, physiology and pathophysiology of the lymphatics is also playing an increasingly important role in modern wound treatment. The primary active mechanisms of manual lymph drainage and lymphedema compression therapy are as follows: increase in lymphangion motor activity and subsequent decongestion of the area affected by lymphedema, removal of lymphostatic protein load, loosening of connective tissue proliferation and improved micro and macrocirculation. Manual lymph drainage may therefore be particularly effective for wound treatment.

Keywords: manual lymph drainage, compression therapy, lymphedema, wound treatment

The "Treatment of chronic lymphedema" care contract in Saxony-Anhalt – Experience with negotiation and implementation

T. Hirsch
LymphForsch 2015; 19(1):41-45

Summary
The success of treating chronic lymphedema, lipedema and related types of edemas in line with guidelines depends on cooperation by the physicians, physiotherapists and medical supply stores involved, as well as on the patient’s compliance. Numerous regional lymphedema networks have recently been founded in Germany with the aim of optimizing organizational procedures and schedules. In order to streamline bureaucratic structures, create legal certainty, and illustrate organizational efforts efficiently, discussions have been conducted with various funding agencies by representatives from the Schönebeck and Saxony-Anhalt (South) lymphedema networks. The discussions were facilitated and supported by the Association of Statutory Health Insurance Physicians of Saxony-Anhalt. Paradoxically, the fact that therapy measures are part of the standard care covered by statutory health insurance schemes has proven to be problematic. This is because inpatient and outpatient treatment is financed by one source and the rehabilitation of gainfully employed persons and retirees by another source. The result of the numerous constructive meetings was a care contract agreed on with AOK Saxony-Anhalt Local Health Care Fund in accordance with Section 73a of the German Social Code, Book V. Once the contract has been signed, solutions will have to be found for implementation-related problems arising from the health insurance providers‘ internal structures.

Keywords: chronic lymphedema, combined decongestive therapy (CDT), lymphedema network, standard care, care contract

Outpatient lymphedema treatment: Possibilities and limits with respect to the current guideline on remedies in Germany

S. Hemm
LymphForsch 2015; 19(1):46-49

Summary
In Germany, outpatient therapy has become established for the treatment of patients with lymphangiological diagnoses. The care and therapy of these usually chronically ill patients require a high level of commitment from all those involved. The budget-related aspects of outpatient therapeutic measures are laid down in the guideline on remedies (Heilmittelrichtlinien) but do not necessarily have to impinge on budget of the prescribing doctor. Through the establishment of national practice characteristics by the Federal Joint Committee (G-BA) in Berlin and the definition of diagnoses which meet the criterion for longterm approval, the expenses for lymphangiological patients can be significantly reduced. A primary requirement for exploiting the prescribing possibilities entails proper issue of prescriptions.

Keywords: outpatient lymphedema treatment, guideline on remedies, long-term approval

Lymphedema networks – Long-term experience with treating patients with acute and chronic lymphedema in Germany

O. Gültig
LymphForsch 2015; 19(1):50-53

Summary
After 15 years of experience, the German lymphedema networks have proven to be an effective tool for managing all forms of lymphedema. This kind of network-based teamwork is superior to the management of lymphedema by a single individual as practiced in the past. The advantages of lymphedema networks can be summarized as follows: The continuous training of all members involved guarantees up-to-date knowledge of modern lymphedema diagnostic and treatment procedures. Standardized treatment guidelines, controlled treatment procedures and effective communication, as well as intra- and interdisciplinary control mechanisms have proven to be extremely helpful tools. Moreover, the networks enable good treatment and rehabilitation results to be achieved more quickly, with the resulting improvement in quality of life. Other benefits include the close supervision of long-term patients and the better comparability of treatment outcomes of different patient groups.

Keywords: lymphedema networks, treatment guidelines, improvement of  treatment results