Abstracts LymphForsch 2/2020

– full text in German –

Improved complaints in patients with lipedema four, eight  and twelve years following liposuction

A. Baumgartner, I. Meier-Vollrath, M. Hüppe, W. Schmeller
LymphForsch 24 (2) 2020, 48-55

In 60 patients with lipedema a single-center study with a mail questionnaire – often in combination with clinical controls – was performed after an average period of 12 years following liposuction. 

All of the patients in this group had already been surveyed 4 and 8 years after surgery. Compared with  the earlier results the improvement  of  complaints such as spontaneous pain, pain upon pressure, edema, bruising tendency and restriction of movement persisted; the same holds true for the patients’ self-assessment of cosmetic appearance, quality of life and general impairment.

While in the period from 4 to 8 years following liposuction minor worsening of symptoms occurred, this was not the  case  in  the  period  8  to  12  years  after surgery.  In  addition  there  was  a  similar reduction in the amount of conservative treatment decongestive therapy, compression garment) as that observed after 4 and 8 years. Compared with before liposuction, 55% of  the  patients  lost  6.2  kg  on  average  and  43.3  %  gained  anaverage  of  7.9  kg. The surgical procedure was well accepted by the patients.These  results  confirm  for  the  first  time  the  long-lasting  improvements  of  complaints (average 12 years) following liposuction in patients with lipedema.

lipedema, liposuction, improvement, complaints, 12-year period, long-term effects

E-mail: ab@hanse-klinik.com­

The effect of aqua cycling on patients with medically diagnosed lipedema preparing for liposuction

J. Kronimus, M. Lampe, M. Jung, J. Kleinschmidt, B. Kleinschmidt
LymphForsch 24 (2) 2020, 56-64

Background: Current treatment standards limit therapy for lipedema to complete physical decongestive therapy (CDT). Aqua cycling should be considered as a new method thatwould make treatment more comprehensive. The study investigated the effect of aqua cycling on female patients with medically diagnosed lipedema preparing for liposuction.

This case series is the basis for further studies testing this hypothesis. Generating moreevidence on the effects of cycling in water may enable the therapy method to be (partially) covered by the statutory health insurance or even be included in the German catalog of remedies.

The study was conducted as part of three controlled individual case studies over

a 10-week intervention period. The patients participated in an aqua cycling course structuredin a standardized manner. The Bodytronic. 600 body scanner, a clinical examination including a specially developed questionnaire of complaints, and the 36-item short form survey (SF-36) were used to collect data. The parameters leg circumference, body weight, swelling tendency, pain and health-related quality of life were collected.

n 2 out of 3 of the study participants, aqua cycling brought about a reduction in leg circumference. In 2 out of 3 cases, the participant experienced weight loss, reduced pain perception and reduced swelling tendency in the edematous area. In 2 patients, health-related quality of life increased, while the data of the third patient does not allow for unequivocal assessment results.

With regard to the parameters investigated, aqua cycling demonstrated a positive effect on patients with lipedema.

aqua cycling, lipedema, manual lymph drainage, physical therapy

E-mail: jung.michael@hs-fresenius.de

Paradoxical scintigraphy findings in patients with primary lymphedema of the lower extremities

W. J. Brauer
LymphForsch 24 (2) 2020, 65-68

Functional lymphoscintigraphy can be used to obtain quantitative information about the lymph transport function in the extremities. Measurement results demonstrating reduced lymphatic transport in patients with the various forms of lymphedema are plausible, becoming more pronounced the more severe the clinical picture. Generally, functional lymphoscintigraphy meets these requirements. Occasionally, however, unexpected results occur which, if detected, are often interpreted as evidence of the assumed unreliability of the method. Or upon closer examination of the clinical context and possible complex pathophysiological backgrounds, apparently plausible findings mean something different than what was initially expected.This article presents the most common paradoxes and explains them to the extent possible. In some cases, however, the explanation must remain hypothetical for the time being.

lymphoscintigraphy, lymphedema, phlebolymphedema, lipolymphedema

E-mail: w.j.brauer@gmail.com

The effectiveness of physical therapy interventions in water compared to manual lymph drainage in patients with chronic lipedema/lymphedema of the lower extremity – A systematic review by two independent investigators

L. Gebhard, E. Schäfer, M. Jung
LymphForsch 24 (2) 2020, 71-75

Background: Lipedema and lymphedema of the lower extremity are chronic progressive diseases of the lymphatic system that can lead to multiple physical and psychological complaints.Therapeutic exercise programs conducted in a pool may be a worthwhile therapy option.

This systematic review aims to answer the following question: Have any studies examined the effectiveness of physical therapy interventions (physical activity such as water therapy) on patients with chronic lipedema/lymphedema of the lower extremity as measured by the change in volume, compared with manual lymph drainage?

The medical database search was independently conducted by two investigators. To identify relevant studies, inclusion and exclusion criteria were defined. The studies identified were rated independently using the PEDro scale and the McMaster form.

While three studies met the inclusion criteria, none of these studies attributed significant improvement in the investigated complaints to water therapy interventions.

Exercise therapy conducted in water is a possible treatment method for patients with lipedema/lymphedema but is not suitable as a replacement for manual lymphatic drainage.

lipedema, lymphedema, manual lymph drainage, aqua therapy, aqua cycling, physical therapy

E-mail: jung.michael@hs-fresenius.de

The initial lymphatics possess a microvalve system

J. Wilting
LymphForsch 24 (2) 2020, 76-79

The structure and function of the initial lymphatic vessels have long been the subject of controversy. Unfortunately, misrepresentations still occur today. Lymph flows from a peripheral to central direction. The autonomous contractility of the lymphatic collectors, which can generate considerable pressure, is the main driving force here. The direction of lymph flow is ensured by two principal valvular systems: the system of semilunar valves in the lymphatic collectors and the system of fine initial valves, which are formed by overlaps between the lymphatic endothelial cells (LECs) of the initial lymph vessels. The basis for these valves is the unique, oakleaf-like shape of these LECs, which allows a large number of overlaps. The “hinges” of the valves are formed by robust cell contacts consisting of VE- cadherin and tight junction molecules. The outer (abluminal) part of the flap is fixed by anchoring filaments. The inner, luminal part opens when the pressure in the interstitium increases and allows fluid to enter the vessel. When the intraluminal pressure increases upon contraction of the collectors, the valve closes again so that lymph is not pressed back into the interstitium. In patients with lymphedema, the initial lymph vessels are massively stretched, which causes the valves to dilate into uncontrolled openings. In patients with lymphedema, this results in a vicious circle. The initial lymphatic vessels in their physiological state have incorrectly been depicted as “open” or “discontinuous”. As in other organ systems, a directed flow in the lymphatic vascular system is only possible when the valvular system is functioning.

initial lymphatics, intercellular contacts, VE-cadherin, anchoring filaments, fibrillin

E-mail: joerg.wilting@med.uni-goettingen.de

Measureable changes in patient quality of life or lymphedema after the first COVID-19 lockdown in Austria

C. Heim-Gruteser, M. Oberjakober, A. Markus
LymphForsch 24 (2) 2020, 91-95

The lockdown imposed in the context of the COVID-19 pandemic from mid-March 2020 to late May 2020 in Austria has led to significant cuts in the care of lymphedema patients. The investigation aimed to determine whether these reductions have any short-term effects on the objective and subjective course of the disease.

lymphedema, pandemic, course of edema, psychological stress, edema

E-mail: a.markus@wittlinger-therapiezentrum.com

Reality of care at a specialized lymphedema clinic in Bavaria – Experiences from the COVID-19 pandemic

K. Pelk, D. Krank, M. Schmidtmann
LymphForsch 24 (2) 2020, 96-99

The COVID-19 pandemic has created medical and physical therapy shortages for patients with lymphedema disorders. Both in-patient and out-patient treatment of these patients was nearly completely suspended in order to free up capacity for COVID-19 patients. For a considerable number of patients, this led to reduced quality of life and exacerbated symptoms, in some cases with dramatic courses. Performing recompensation therapy in these patients will be a huge challenge. The current increase in the number of COVID-19 cases threatens to cause new restrictions in treatment options for patients with lymphedema at our clinic.

lymphological disorder, complete physical decongestive therapy, COVID-19 pandemic, lockdown

E-mail: k.pelk@klinikum-fichtelgebirge.de