Possibilities of Conservative Treatment of Patients with Secondary Lymphatic Edema of the Low Extremities

Up-to-date treatment of patients with lymph edema of different origin based on various (operative and conservative) treatments. However, the immediate and long-term results of current surgical interventions show that they do not always have the desired effect. The modern concept of conservative therapy involves the use of complex pathogenetic physical, pharmacological and rehabilitation measures, each of which affects a certain link of pathogenesis. The purpose of the study Improve the results of a comprehensive conservative treatment of patients with chronic lymphatical edema of the lower extremities secondary aetiology. Materials and methods We analyzed the results of a comprehensive survey of clinical and instrumental examination and subsequent treatment of 223 patients. Of these, 190 patients with C3-C6 CEAP classes at a secondary disorders of lymphatic drainage of venous origin: class C3 – 78, C4 – 64, C5 - 20 and C 6 - 28 people. In 46 patients had grade I edema was detected in 133 grade II and 44 - III degree. To survey and to monitor patients were used anthropometry, computed tomography, duplex angioscanning, ultrasound studies of limbs soft tissue and lymph nodes, clinical motion analysis, computer thermograthy, the sample of McClure and Aldrich and lymphoscintigraphy. Medical therapy included a diverse group of drugs - flebotoniki, limfotoniki, anti coagulants profibrinolitiki, rheological, antiplatelet agents, antiplatelet and diuretics. According to medical evidence were used adjunctive agents. Used compression therapy, biomechanical pnevmovibrostimulation, gravity therapy, methods and endolymphatic lymphotropic therapy, magnetic field and laser effects. Results and their discussion Observations showed that the combined treatment of all patients reported disappearance or reduction of sense of heaviness and fullness in the affected limb. Dynamics of measures of limb circumference showed decreasing perimeters at the foot and the lower third of the leg, was celebrated symmetric cycle step through the orthopedic correction and a set of special gymnastic exercises, as well as biomechanical pnevmovibrostimulation with elements of the locomotor remodel. According to the ultrasound scan extremity soft tissue vibrations set thickness and echogenicity was a decrease in the linear dimensions of the lymph nodes and change their structure. According to the results of duplex angioscanning revealed a significant increase in the linear and volumetric blood flow in the great saphenous vein, the superficial and deep veins of the thigh. By CT scan of limbs were noted changes in the density of the subcutaneous tissue. Indicators of computer thermography expressed in enhancing the infrared radiation and increase the absolute and relative margin settings hyperthermia. According to a sample of McClure and Aldrich observed a moderate increase in the time of absorption of skin induration, while lymphoscintigraphy percentage of residual radioactivity decreased, and the rate of lymph flow increased in patients with I-II degree of edema. Conclusion All of the above diagnostic and therapeutic measures used in the complex, both provide adequate influence in secondary lymph violations, prevent the development of complications and provide adequate preoperative and postoperative effective medical and social rehabilitation of patients with chronic secondary lymph edema of the lower extremities.

Chronic lymphatic insufficiency, inspection, conservative treatment, preoperative preparation