Background

In the treatment of lymphedema, a plastic surgeon carries out only surgical treatment, whereas a therapist performs only complex physical therapy. Therefore, a combination treatment strategy is not performed in most cases. Our institution combines a lymphaticovenular anastomosis (LVA) operation with complex physical therapy during the same hospitalization.

Methods

From advanced cases of lymphedema of stage II or higher, we included patients who were hospitalized for 2 weeks or more for combined LVA and complex physical therapy. Of the 28 cases studied, 26 were secondary lymphedema and two were primary lymphedema. There were seven upper limb cases and 21 lower limb cases. The mean length of hospital stay was 12 days (7-14 days). We performed a multisite LVA in all 28 patients. The mean number of anastomoses in each case (the side with the most edema for bilateral cases) was 3.96 (2-6). During hospitalization, lymphatic therapists who were familiar with complex physical therapy for lymphedema were trained to provide total care for lymphedema. The content of the education was applied according to the individual patient's status, and an emphasis was placed on development of a treatment regimen that patients could perform continuously by themselves after discharge.

Results

The average volume reduction in seven patients with upper limb lymphedema was 15.1%; the average in 18 patients with lymphedema of the lower limbs was 13.1%. The average volume reduction in eight patients at stage II was 14.1%; stage II late was 13.0%, and stage III was 14.7%. The other three cases had suffered an exacerbation, and the mean exacerbation was 3.2%. Among the 12 patients who had cellulitis preoperatively, an episode of cellulitis was detected in only two patients during follow-up postoperatively. These two patients were those at late stage II and stage III. The frequency of onset decreased in these two cases.

Conclusions

In this study, combination therapy was administrated for lymphedema. We obtained good results in the diseased limbs, including volume reduction and prevention of cellulitis. Therefore, combination therapy might be useful for lymphedema cases at advanced stages.

中文翻译：

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手术和保守疗法联合治疗晚期淋巴水肿的实用性。

背景

在淋巴水肿的治疗中，整形外科医生仅进行外科手术治疗，而治疗师仅进行复杂的物理治疗。因此，大多数情况下不执行联合治疗策略。我们的机构在同一住院期间将淋巴管吻合术（LVA）手术与复杂的物理疗法相结合。

方法

从II期或更高阶段的淋巴水肿的晚期病例中，我们纳入了因LVA和复杂的物理疗法而住院2周或更长时间的患者。在研究的28例病例中，有26例为继发性淋巴水肿，其中2例为原发性淋巴水肿。上肢7例，下肢21例。平均住院时间为12天（7-14天）。我们对所有28例患者进行了多站点LVA。在每种情况下（双侧病例中水肿最多的一侧）的平均吻合数为3.96（2-6）。在住院期间，对熟悉淋巴水肿复杂物理疗法的淋巴治疗师进行了培训，可以为淋巴水肿提供全面护理。教育内容根据患者的个人情况进行应用，

结果

7例上肢淋巴水肿的平均体积减少为15.1％；18例下肢淋巴水肿的平均发生率为13.1％。II期的8名患者的平均血容量减少了14.1％。第二阶段晚期为13.0％，第三阶段为14.7％。另外三例病情加重，平均病情加重3.2％。术前有蜂窝织炎的12例患者中，只有2例在术后随访中发现蜂窝织炎发作。这两名患者分别处于第二阶段和第三阶段。在这两种情况下发病率降低。

结论

在这项研究中，联合治疗淋巴水肿。我们在患病的四肢上取得了良好的效果，包括减少体积和预防蜂窝织炎。因此，联合治疗可能对晚期淋巴水肿病例有用。