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Literature search on morbidity control of lymphoedema

Literature search on morbidity control of lymphoedema


We did a literature search of Cochrane, Pub Med and Traditional medicine databases to identify the studies on interventions for lymphoedema including Lymhatic Filariasis. We designed the search strategy to include maximum studies and types of the interventions published

Search Strategy for identifying studies in PubMed and Cochrane Central Register of Controlled Trials:

(Primary lymphedema OR Secondary lymphedema OR Filarial lymphedema OR Lymphatic filariasis OR lipedema OR Milroy lymphedema OR Phlebo lymphedema OR Lymphedema) AND (treatment OR management OR morbidity management) AND (Limb volume OR Volume OR Limb circumference OR Circumference OR Limb girth measurement OR Girth measurement OR Girth OR Quality of life OR Health related quality of life OR Bacterial entry points OR Bacterial entry lesions OR Entry lesions OR Acute dermato-lymphangio-adenitis OR ADLA care OR inflammatory episode OR inflammatory episodes) NOT (upper limb lymphedema OR breast cancer related lymphedema OR BCRL OR post mastectomy lymphedema OR mastectomy OR breast cancer)


Two investigators (Dr Sushma and Dr Guruprasad) independently screened all studies and classified them. Dr Narahari reviewed these tables.

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Cochrane review

Controlled clinical trials on morbidity management of lymphoedema was retrieved from Cochrane CENTRAL .This search yielded 39 studies. 16 were relevant for morbidity control. We have classified these interventions as

  1. Medical interventions

  1. Complex decongestive physiotherapy (2 studies )

  2. Compression therapy (3 studies)

  3. Drug therapy (8 studies )

  4. Miscellaneous (1 studies )



  1. Other biomedical treatment (2 studies)

Table below lists all studies under the above classification

  1. Medical intervention

  1. Complex decongestive physiotherapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Intensive treatment6- to 8-h sessions in the outpatient clinic 1

23 legs of (19 patients)

Prospective

Randomized clinical trial

Volume

The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema

Complete decongestive physiotherapy (CDP) and combined with intermittent pneumatic compression (IPC)2

11

Prospective, randomized trial

Volume

To study whether complete decongestive physiotherapy (CDP) alone or combined with intermittent pneumatic compression (IPC) could improve the treatment outcome in women with lipedema



  1. Compression therapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Compression bandaging3

  • two-component compression (2CC) system

  • conventional inelastic multicomponent compression bandages (IMC)


30

Prospective randomized, controlled trial

Volume

Loss of

interface pressure


Compare the effectiveness of a two-component compression (2CC)

system with conventional inelastic multicomponent compression bandages

Compression stockings4

14

Pilot study

Volume

To investigate whether the early use of compression stockings is effective in preventing leg lymphedema. Fourteen patients undergoing inguinofemoral lymphadenectomy for vulval cancer were randomized to either best supportive care or best supportive care plus the use of graduated compression stockings for 6 months

Short-stretch bandages5


20

Controlled comparative study

Volume

The aim was to demonstrate that therapeutically intended volume reduction of the compressed leg is the most important cause for the loss of bandage pressure



  1. Drug therapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

5,6-benzo-[alpha]-pyrone6

31

Randomized, double-blind, placebo-controlled

Volume

Girth

ADLA

QOL

To study the effect of 5,6-benzo-[alpha]-pyrone in arms and legs lymphedema

Doxycycline7

18

Double-blind, placebo-controlled trial

Volume

Grading

18 lymphedema patients took part in a double-blind, placebo-controlled trial of a 6-wk regimen of 200 mg/day doxycycline. Four months after doxycycline treatment, all patients received 150-200 microg/kg ivermectin and 400 mg albendazole

5,6-benzo-alpha-pyrone( two 200mg and two placebo

Tablets) 8

104

Randomised, double blind, placebo controlled study

Volume

ADLA

The study reveals that 5,6-benzo-alpha-pyrone reduces the oedema and many symptoms of filarial lymphoedema and elephantiasis along with compression garments

  1. 800 mg oral penicillin

  2. 1 mg DEC/kg

  3. 800 mg oral penicillin plus 1 mg DEC/kg

  4. local antibiotics

  5. Placebo 9

150

Double-blind, placebo-controlled study

ADLA

To study of the efficacy of oral penicillin, diethylcarbamazine or local treatment of the affected limb in preventing acute adenolymphangitis in lymphoedema caused by brugian filariasis

5,6 benzo-[alpha]-pyrone (coumarin, '56 BaP') and of diethylcarbamazine (DEC)10

169

Randomized double-blind, placebo-controlled, trial

Volume

To study the effects of 5,6 benzo-[a]-pyrone (coumarin) and DEC on filaritic lymphoedema

Ivermectin (400 micrograms/kg),

DEC (10 mg/kg)

placebo 11

120

Double-blind, placebo-controlled study

ADLA

To study efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence

of ADL

DEC group

and placebo group 12

98 Male

Double-blind, placebo-controlled study

Girth

Ultrasonographic measurements

Study with diethylcarbamazine for

the treatment of hydrocoele

  1. 5,6benzo-[alpha]-pyrone (coumarin 1,2 benzopyrone, 400 mg/day) or placebo

  2. Heat (using microwaves) coupled with compression garments13

6

Randomized study

Volume

Girth

Tonometry

QOL

To study the use of 5,6 benzo-[alpha]-pyrone (coumarin) and heating by microwaves in the treatment of chronic lymphedema of the legs








  1. Miscellaneous

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

  1. Standard physiotherapy plus manual lymph drainage14

  2. Physiotherapy but no lymph drainage

23

Randomized clinical trial

Volume

To study the relative efficacy of this treatment component Manual lymph drainage after hindfoot operations






  1. Other biomedical treatments

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

15.

Quality of life of patients with different conservative treatment 15

34

Case series

QOL

To study quality of life of patients receiving conservative treatment

16.

Raised leg exercises16

245

Case series

Girth

To study the effect of raised leg exercises for leg edema in the elderly







Pub Med review

This search yielded 449 studies. 112 were relevant for morbidity control. We have classified these interventions as

1. Surgical interventions:

  1. Lympho venous anastamosis (29 studies)

  2. Omental Plasty (3 studies)

  3. Skin and Soft tissue excision (3 studies)

  4. Other surgical interventions (8 studies)

  5. Surgical interventions followed by medical management (3 studies)

  6. Liposuction (2 studies)

2. Medical interventions

  1. Complex decongestive physiotherapy (18 studies )

  2. Compression therapy (7 studies)

  3. Integrative treatments (6 studies)

  4. Drug therapy (6 studies )

  5. Advice on wash and hygiene (1 studies)

  6. Manual Lymph drainage(1 studies )

  7. Others (1 studies)

3. Medical devices for lymphoedema(11 studies)

4. Other biomedical treatments

  1. Quality of life studies (1 studies)

  2. Questionnaire studies(4 studies)

  3. Exercise studies (1 studies)

  4. Miscellaneous (6 studies)

Table below lists all studies under the above classification

  1. Surgical interventions

  1. Studies on Lympho-venous anastamosis

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Lymphovenous microsurgical shunts17


1300

Expert onion

Girth

Heaviness

Pain

Mobility

45-year experience of one surgeon(Patients were classified into groups according to the etiology of lymphedema as postinflammatory /posttraumatic, postsurgical, idiopathic and hyperplastic)

MinimallyInvasive Lymphatic Supermicrosurgery18

11 limbs

Case series

Volume

Minimally invasive lymphatic supermicrosurgery can serve as the most reasonable treatment of

compression-refractory peripheral lymphedema

Lymphaticovenular anastomosis19

11 female

Case series

Volume

Lymphocele size

LVA is a therapy for lymphocele caused by an obstruction of the lymphatic flow

π-shaped lymphaticovenular anastomosis20

4 (3patients had unilateral lymphoedema, 1 bilateral

Lymphoedema)

Pilot study

QOL

Girth

Volume

The treatment was attempted in chronic head and neck lymphoedema

Modified side-to-end lymphaticovenular anastomosis21

14 limbs(female)

Case series

Volume

LEL index.


Modified S-E LVA divert lymph flows into venous circulation without performing supermicrosurgical anastomosis. After completion of S-S anastomosis, the vein distal to the anastomosis site was ligated to prevent venous backflow and subsequent thrombosis at the anastomosis site

Scar less lymphatic venous

anastomosis22

6(8 legs)

Case series

Girth

Lymphoscintigram

The vessels and veins were secured with vessel loops passed underneath and side-to-side anastomosed under a surgical microscope

Microsurgical LVA23

1800

Case series

Volume

Lymphoscintigraphy

To report the wide clinical experience and the research studies in the microsurgical treatment of peripheral lymphedema

Supermicrosurgical lymphaticovenous anastomosis and lymphaticovenous

implantation24

101

limbs(80 primary and 21 with secondary )

Case control study

Volume

Study was to compare the intraoperative findings and outcomes of primary and secondary lower-extremity lymphedema cases treated with lymphaticovenous shunts

Supermicrosurgical

lymphaticovenular anastomosis and/or lymphaticovenous implantation25

42(Thirty patients were

women and 12 were men)

Case series

Volume


Reported here is the 2 years experience on supermicrosurgical

 lymphaticovenularanastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for  treatment

 of lower extremity lymphedema

Lymphatic tissue transplant26

9


Volume

The study evaluation of the long-term (10 years) effects of autologous lymphatic tissue implant in lymphedema

Lymphaticovenular anastomosis 27

2

Case series

Girth

Two patients with secondary skin lesions of

chronic lymphedema one patient exhibited acquired lymphangioma circumscriptum of the vulva and the other presented elephantiasis nostras verrucosa of the lower leg

Lymphangiectomy and

reconstruction with local flaps 28

2

Case series

QOL

Scrotal lymphedema treated by excision and anterior and posterior flap reconstruction

Microsurgical lymphatic-venous anastomoses29

about1500

Case series

Volume

ADLA


In patients where a venous

disease was associated to lymphedema, reconstructive lymphatic microsurgery

techniques were performed (lymphatic-venous-lymphatic-plasty)

Microsurgical lymphatic-venous anastomoses 30

1000

Case series

Volume

ADLA

For those cases where a venous disease is associated to more or less latent or manifest lymphostatic pathology of such severity to contraindicate a lymphatic-venous shunt, reconstructivelymphatic microsurgery techniques have been developed (autologous venous grafts

or lymphatic-venous-Iymphatic-plasty - LVLA)

Minimal invasive lymphaticovenular anastomosis31

52

Case series

Girth

To study the effectiveness of minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema for stage III and IV

Microsurgical lymphonodovenous implantation32

10(14 limbs)

Case series

Girth

To study the effect of microsurgical lymphonodovenous implantation for chronic lymphedema


Microsurgical lymphatic-venous anastomoses33

676

Case series

Volume

ADLA

To analyis clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy

12 cases- conservative treatment

13 cases- lymphaticovenular anastomoses34

25

Case control study

Girth

Comparing the use of supermicrosurgical lymphaticovenular anastomosis and/or conservative treatment

LVA(lymphovenous

Anastomosis) 35

13

Case series

Volume

QOL

To find the effect of LVA in lower limb lower limb lymphoedema(LVA failed to improve the volume of lower limb LE and reduce the frequency of erysipelas)

Lymphatic-venous anastomoses36

665

Case series

Volume

ADLA

To study the long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema

Lymphonodovenous shunt37

75

Case seies

Volume


The aim of the trial was to identify a cohort of responders as against non-responders and to correlate the outcome with various factors

  • Femoropopliteal bypass reconstruction by lateral groin incision

  • Femoropopliteal bypass reconstruction by direct incision over the femoral vessels38

24

Randomized clinical trail

Volume

Lymphoscintigraphy evaluation

To see whether the type of groin incision influenced the degree of postoperative leg oedema and the occurrence of lymphatic damage

Lymphovenous anastomoses39

152

Case series

Volume

ADLA

Heaviness

To study the late results of LVA

Microlymphaticovenous anastomoses 40

134

Case series

Volume

Girth

Lymphosentigraphy evaluation

ADLA

To study the long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema

Lymph nodovenous shunt

(LNVS) and Charles' operation 41

44

Cross sectional study

Volume

Girth

Skin condition

Mobility

A review

Lymphaticovenous anastomosis 42

31

Retrospective observational study

Volume


The present study aimed to determine the net effect of lymphaticovenous side-to-end anastomosis (LVSEA) in patients with lower limb lymphoedema treated by preoperative CDP

LVSEA (lymphaticovenous anastomosis)43

107 patients

Cohort

Volume

To determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography

Lymph nodovenous shunt

(LNVS) and Charles' operation 44

44

Cross sectional study

Volume

Girth

Skin condition

Mobility

A review

Lymphaticovenous anastomosis 45

31

Retrospective observational study

Volume


The present study aimed to determine the net effect of lymphaticovenous side-to-end anastomosis (LVSEA) in patients with lower limb lymphoedema treated by preoperative CDP







  1. Studies on Omental plasty



SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Pedicled Omental flap 46

4

Case series

Girth

QOL

Review of literature. Unilateral, secondary lymphoedema of the lower limb were treated

Pedicled omentoplasty 47

7

Case series

Pilot study

Girth

We evaluated the possible benefit of a pediculated omentoplasty placed in the groin for preventing complications after ilioinguinal lymph node dissection

Omentoplasty 48

20


Volume

ADLA

To assess its role in the reduction of oedema volume after failed lymphonodo-venous shunt (LNVS) or as a primary procedure













  1. Studies on Skin and soft tissue excision

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Modified Charles procedure49

8(primary lymphoedema)

Case series

QOL

The modification entailed the use of a negative-pressure dressing after the initial debulking surgery and then the delay of skin grafting by 5 to 7 day

Charles procedure 50

17

Case series

QOL

The study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region

Staged skin and subcutaneous excision 51

38 (6 male; 32 female

Case series

Volume

ADLA

To find the effect of Staged skin and subcutaneous excision beneath skin flaps in lower limb oedema



  1. Studies on other surgical intervention

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Contralateral rectus abdominis musculocutaneous flap52

4

Case series

Girth

ADLA

A contralateral RAM flap with an inferior cutaneous pedicle left intact to facilitate lymphatic drainage into the unaffected groin

Cutaneous resection 53


3(primary lymphoedema)

Case series

Volume

Patients treated for 3 to 5 weeks with decongestive physiotherapy and then followed by one or two cutaneous resections

24patients- lymphonodovenous shunt (LNVS), 54 patients- Charles' operation, 18 patients- Sistrunk's or Thompson's operation54

96

Cross sectional study

Volume

Girth

Evaluation of different surgical procedures

Fluoroscopy-guided LSGB(lumbar sympathetic ganglion block)lumbar sympathetic ganglion block )( 3 times at 2-week intervals55

18

Case series

Girth

Heaviness

LSGB was offered tolower limb lymphoedema after gynecologic cancer treatment

Complete excision of lymphocele and microsurgical lymphatic-venous anastomoses56

16

Case series

Volume

Inguinal lymphocele associated with lower lymphoedema successfully treated by microsurgical reconstructive procedures and studied by LS(lymphoscintigraphy)

Iliac vein stenting57

443


Volume

Pain

Lymphangiography

The study comprised CVD(cardio vascular disease) patients who underwent iliac vein stenting (Diagnosis and treatment of venous lymphedema)

Lymphatic venous transplantation58

212

Case series

QOL

Quality of life of patients with lymphedema after lymphatic vessel transplantation and conservative therapy for at least 6 months prior to operation

Preoperative elastography and LVA59

11

Case series

Girth

Hardness

Value of ultrasound elastography for

the diagnosis of early-stage lymphoedema ,determination of LVA sites and to find efficacy

of treatment



  1. Studies on surgical intervention followed by medical

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Compression therapy and liposuction60

1

Case report

Volume

ADLA

Pain

Circumferential liposuction was done to remove hypertrophic fat deposits, facilitate conservative therapy, and decrease further risk of

Cellulitis

Excisional surgery along with postoperative CDT/compression therapy61

22 patients(33 limbs)

Case series

QOL

ADLA

To improve clinicalmanagement

Lymphaticovenous anastomosis and Complex decongestive physiotherapy62

31


Volume

To find the effect of lymphaticovenous anastomosis on volume reduction of peripheral

lymphoedema after complex decongestive physiotherapy. 37 LVSEAs was performed in 31 patients













  1. Studies on Liposuction

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Liposuction63

25


Volume

Pain

Liposuction reduces the symptoms of lipedema significantly. The parameters were measured using visual analogue scales (VAS, scale 0-10)

Tumescent liposuction 64

28

Case series

QOL

To determine the efficacy and safety of surgery (liposuction)

concerning appearance and associated complaints



  1. Medical interventions

  1. Studies on complex decongestive physiotherapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Complex decongestive therapy65

158(secondary lymphoedema)

Retrospective Case study

Volume

Two weeks of CDT along with self-administered home therapy and were followed up

Comprehensive decongestive

therapy66which includes skin care, an exercise regimen, manual lymphatic

drainage (MLD) and regular bandaging

24 patients

(8 women with arm lymphoedema16 men and women with lymphoedema of the lower limb)

Case series

Volume

QOL

This study was established to determine the effectiveness of a new system of bandage therapy, the 3M™ Coban™ 2 compression

system


Complete decongestive physical therapy67

1 (developed

lower-extremity lymphedema secondary to orthopedic trauma)

Case report

Volume


To find the response to complete decongestive physical therapy (CDP), with 8 treatment

sessions over 3 months

Group I= complex physical therapy in-hospital [Phase 1]

Group O= complex physical therapy on an outpatient-basis without having Phase 168

30

Case control study

Volume


Impact of aggressive decongestion on the maintenance phase in combined physical

therapy.

Ist phase- Compression bandages

2nd phase- hygiene, skin care, exercise, and leg elevation + no Compression bandages 69

175

Case cross over

ADLA

Volume

To evaluate the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings.

Decongestive lymphedema therapy70

1(primary lymphoedema)

Case report

Girth

The goals of physical therapy intervention

were as follows: 1) to reduce total limb girth circumference for both lower extremities; 2) to improve skin texture; 3) to promote independence with skin care to reduce the risk of infection; and 4) to facilitate independence with

self-management

Complete decongestive physical therapy71

12(secondary lymphoedema

Case series

QOL

Girth

To investigate if individual's lymphatic system can benefit from complete decongestive physical therapy

Complex decongestive physiotherapy72

38


Capillary resistance (CR) or altered capillary fragility (CF).

Twenty-one (21) patients were treated with CDP and 17 using exclusively moisturizers as the control group. 38 women with

lipedema were included in the study

Comprehensive treatment73

complete decongestive therapy (CDT), muscle energy techniques, core stabilization, and the application of a pelvic support belt

1

Case report

Volume, increased lower abdominal and lumbar extension strength, and decreased Oswetry Disability Index ratings

To describe the examination, diagnosis, and

intervention for a patient with lower extremity lymphedema and sacroiliac joint

dysfunction.

Complex decongestive physiotherapy74

57

Post treatment for gynecological

cancer.

Case series

Volume

QOL

Effect over lower unilateral lymphoedema following cervical cancer therapy


  1. Complete decongestive physiotherapy alone

  2. Complete decongestive physiotherapy with pneumatic compression 75

11 women

Randomized trial(a pilot study)


Volume

To study CDP and IPC could improve the treatment outcome in women with lipedema

Complex physical therapy76

20

Case series

Volume

Lymphscintigraphicy finding

Lymphscintigraphic findings can predict

long-term response to complex physical therapy (CPT) in patients with early stage extremity lymphedema

Manipulative therapy (Complete decongestive therapy (CDT), including manual lymphatic

drainage (MLD)) 77

(phase 1 & 2)

72 (82 limbs)


Girth

Volume

CDT consists of treatment (Phase 1) and maintenance phases (Phase 2).During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins

Complete decongestive physical therapy(Twice-weekly) 78

1

case report

Girth

ROM

Twice-weekly management of lymphedema using a program of skin care,manual lymph techniques, compression, and exercise

Combined physical therapy79

45

Case series

Volume

To investigate clinical and paraclinical criteria able to predict responses to combined physical treatment

Complete decongestive physiotherapy80

14

Retrospective case series study

Volume

To study the effectiveness of complete decongestive physiotherapy for the treatment of lymphedema following groin dissection for melanoma(retrospective review of the medical records of 14 patients)

Noninvasive complex lymphedema therapy 81

119

Case series

Volume


To find the reduction in lymphoedema after

complex lymphedema therapy

1 group: Manual lymph drainage

(MLD),intermittent pneumatic compression (IPC), and multilayered short-stretch bandaging82

2nd group: moisturizers

38 women(lipoedema),19 as control group

Non randomized Controlled clinical trial


Volume

Pain

Capillary fragility

Pain was evaluated with a 10-item questionnaire, a pain rating scale (PRS), and the Wong-Baker Faces scale. Treatment consisted of once daily manual lymph drainage (MLD),intermittent pneumatic compression (IPC), and multilayered short-stretch bandaging performed throughout a 5-day-course .19 serving as the control group using exclusively moisturizers





  1. Studies on compression therapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

  1. Best supportive care

  2. Best supportive care plus the use of graduated compression stockings 83

14

Randomized controlled pilot trial


Volume

QOL

To study if early use of compression stockings is effective in preventing leg lymphedema

Inelastic bandage compression84

1

Case report

Girth

Volume

Inelastic bandage is an adaptation of the manual lymphatic drainage

Compression (short-stretch bandages)85

29( 20 lymphedema patients and 9 healthy persons)

Case control study

Volume

The aim was to demonstrate that therapeutically intended volume reduction of the compressed leg is the most important cause for the loss of bandage pressure

Elastic Stockings

86

65

Case control study

Volume

Fifty patients received below-knee elastic stockings, whereas the remaining 15 did not use any compressive device (to evaluate its effectiveness in KS(Kaposi's sarcoma) related lymphedema)

Elastic stockings 87

115(41 primary lymphedema and 74 secondary)

Case series+ subgroup analysis

Girth

To assess the efficacy of compression therapy alone, author report herein the

long-term results of leg lymphedema using elastic stockings

Compression88

49

Case series

Girth

To assess the long-term effects of a program entailing (1) SEP, (2) elastic compression stockings to maintain the post-SEP girth, and (3) daily skin care

Elastic compression(elastic stockings with 24 mm Hg of pressure) 89

103

30 normal, asymptomatic controls & 73 symptomatic

patients

Case control study

Volume

Girth

Pain

To find the efficacy of graded elastic compression in the lower leg



  1. Studies on integrative treatment

Si.no

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Integrative treatment90

730

Non randomized interventional study

Volume

BEP

ADLA

QOL

Self care and integrative treatment is possible in resource poor Indian village settings

Integrative treatment (skin care and daily yoga and breathing practices )91

446 patients

Cohort (observational)

QOL

Community based one day camps that trained LF patients on skin care and daily yoga and breathing practices improved QoL

Integrative treatment92



ADLA

Volume

Self help and family members assisted in home-based care which include compression

bandaging, yoga exercises, heat therapy using steaming, and skin care

Integrated care treatment93

93 (44 of these underwent surgical treatment )


Case series

Frequency of erysipelas

QoL

To investigate the frequency of erysipelas in patients with genital lymphedema and genital lymphatic cysts who underwent evaluation for surgical treatment

To observe the influence of resection operations on the frequency of erysipelas, and to measure changes in the quality of life due to the resection

Integrative treatment94

638

Case series

Volume

ADLA

volume reductions of 13.3% and 23% on day 14 and 23.4% and 39.7% on day 90 of treatment in small and large limbs.Inflammatory episodes before the onset on this treatment was reported by 79.5% of our lymphedema patients, and 9.4% reported this at the end of three months after our treatment

Integrated treatment 95

261

Case series

Volume

ADLA

QOL

Soap wash, phanta soaking, Indian manual lymph drainage (IMLD), pre- and post-IMLD yoga exercises, and compression using bandages for 194 days, along with diet restrictions and oral herbal medicines







  1. Studies on drug therapy

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Intravenous pamidronate96

12

Case series

Volume

circumference

Patients received intravenous pamidronate monthly for 3 consecutive months and were followed by measuring any discomfort with visual analog scale (VAS) and physician global assessment. This study aims to determine the effectiveness of pamidronate on lymphedema and its possible side effects

Selenium(350 microg/m(2) body surface sodium selenite medication

p.o. daily (total dose 50 microg per day) 97

36


QOL

To investigate the impact of selenium in the treatment of lymphedema

of the head and neck region after radiotherapy alone or in combination with

surgery

  • Daflon (500 mg) + DEC (25 mg)

  • DEC (25 mg) alone, twice daily for 90 days 98

26

Double-blind clinical trial

Volume


To compare the effect of two drugs on volume reduction

Ortho-beta-hydroxy-ethyl rutosides therapy 99

44

(27lymphedema 17 healthy controls)

Case control study

Volume

Girth

Tissue tension

Mobility

To study the clinical

characteristics and the humoral immune pattern in lymphedema patients undergoing

O-beta-hydroxy-ethyl rutoside therapy

Intraarterial lymphocyte-injection 100

1

Case report

Girth

To examine the distribution of the In-111 oxine labeled lymphocytes injected into the proximal artery to the affected leg in comparison with the distribution in the other,healthy leg

Hidrosmin101

20 women

Case series

Volume

Scoring scale


To study the action of hidrosmin in chronic lymphedema











  1. Advice on wash and hygiene

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

(1) education on aetiology and prevention of podoconiosis, (2) foot hygiene(daily washing with soap, water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5) emphasis on the consistent use of shoes and socks 102


33

Case series

The clinical staging system for podoconiosis, the Amharic

Dermatology Life Quality Index (DLQI),

Digital photographs

A study showed simple techniques to manage podoconosis



  1. Manual Lymph Drainage

SI. No

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

MLD103

27 legs of 18 patient

Case series

Girth

TDC(tissue dielectric constant)

The goal was to determine the suitability of TDC method to evaluate lymphedema changes



  1. Others

Si.no

Intervention

Number of patients

Study design

Outcomes used in the study

Comments

Physiotherapy technique (consisted of utilizing sticks, rollers or other cylindrical, flexible, and malleable material which served as a lymph promoting drainage device)104

15

Case series

Girth

Lymphoscintigraphy finding

The aim of the present study was to evaluate a new, more simplified physiotherapy technique for management of peripheral lymphedema









  1. Medical device for lymphoedema

    SI. No

    Intervention

    Number of patients

    Study design

    Outcomes used in the study

    Comments

    Electro-sound wave and vacuum medical device105

    8

    (Case series) Observational study

    Volume

    Lymphosentigraphy

    Dermal back flow

    Ten daily sessions with an electro-sound wave and vacuum medical device were performed along with compression stockings

    Mechanical lymph drainage accompanied with heat106

    7 patients

    Case series

    Volume

    This study was to find the effect of mechanical lymph drainage accompanied with heat on lymphedema.



    Low Level Laser Therapy107

    1

    Case report

    Girth

    Patient with right lower extremity lymphedema praecox was treated through Low Level Laser Therapy

    Multifrequency bioelectrical impedance analysis (MFBIA)108

    120 control group of 29

    Non randamozied clinical trial

    Girth


    The objective was to establish the methodology of

    MFBIA for lower-limb lymphedema and to detect a lymphedema in patients undergoing cervical cancer surgery.Among 120 patients,60 patients undergoing cervical cancer surgery, 39 underwent radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery

    SIPC device109

    43 limb

    Case series

    Girth

    To study, a new mode for SIPC and evaluate its clinical results with higher pressures.

    Sequential intermittent pneumatic compression (SIPC)110

    28

    Case series

    Volume

    ADLA

    To assess the volumetric

    response to the use of sequential intermittent pneumatic compression (SIPC)

    Magnetic fields,

    vibration and hyperthermia111

    10

    Case series

    Volume


    To find the effect of combined modality therapy for treatment of lymphedema


    Sequential intermittent pneumatic compression112

    11

    Case series

    Girth

    Lymphoscintigraphic image interpretation

    To study the effect of sequential intermittent pneumatic compression in volume reduction and on lymph transport

    • 5,6 benzo-[alpha]-pyrone (coumarin 1,2 benzopyrone, 400 mg/day) for six months + (next six months a standardized regimen of heat (using microwaves) +compression garments);

    • placebo for six months + (next six months a standardized regimen of heat (using microwaves) +compressiongarments) 113

    60

    Double-blind,

    Randomized placebo-controlled study

    Volume

    Girth

    To find the use of 5,6 benzo-[alpha]-pyrone (coumarin) and heating by microwaves in the treatment of chronic lymphedema of the legs.

    Tonometry 114

    9


    Volume


    Girth

    ADLA

    Tissue tonometry was used to assess the outcome of microwave hyperthermia, to assess lower extremity lymphedema.


    Wright linear pump 115

    73(78 limbs)

    Case series

    Girth

    To find the effect of Wright Linear Pump for lower extremity lymphedema in adult

  2. Other treatments

  1. Quality of life study



SI. No

Intervention

Number of patients

Study design

Outcome

Comments

Quality of life in Podoconsis116

74

Cross-sectional study

DLQI score

Dermatology Life

Quality Index (DLQI) among patients with podoconiosis

Seven domains

five levels (7D5L) instrument117

174

QOL tool development


Developing QOL tool for field condition

  1. Questionnaire studies

    SI. No

    Intervention

    Number of patients

    Study design

    Outcome

    Comments

    Survey of treatment practices118

    188

    Questionnaire survey

    QOL

    Study describes the results of a baseline survey of a lymphoedema morbidity management

    Interview and examination119

    119

    Questionnaire survey

    Intertrigo

    ADLA

    Data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas

    Interviews120

    101

    Questionnaire study


    The interviews were conducted prior to the introduction of a programme of community home-based care (CHBC) that incorporates modern lymphoedema-management strategies (regular washing, careful drying, and treatment, with antifungal, antibiotic or emollient creams, of the affected limbs, limb elevation, exercise, and use of footwear)

    Interview 121

    40

    Questionnaire study

    QOL

    questionnaire study to find consequences of hydrocele and impact of hydrocelectomy;

  2. Exercise studies

SI. No

Intervention

Number of patients

Study design

Outcome

Comments

Weight lifting122

10

Case series

Volume

ADLA

QOL

To find that weight lifting can be performed by in patients with lower-extremity lymphedema secondary to cancer.(Twice weekly slowly progressive weight lifting, supervised for 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months)



  1. Miscellaneous

SI. No

Intervention

Number of patients

Study design

Outcome

Comments

Mechanism for chronic filarial hydrocele with implications for its surgical repair.123

(1)Group 1-968

uni- or bilateral

filarial hydrocele

(2) Group (CG) of 218 already had undergone hydrocele-sac-sparing hydrocelectomy


Case control study

Intrascrotal lymphangiectasia, gross

appearance/consistency of the testis

To evaluate the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis in endemic area

Community home-based care (CHBC) 124

163

Cohort

Volume

Entry lesion

Grading

Preventing acute adenolymphangitis in patients with lymphoedema caused by bancroftian filariasis

New clinical (C) and laboratory (L) staging systems to improve

the clinical management of chronic lymphedema125

220

Retrospective study


We propose that these two separate staging systems could now become a new guideline for improved management of lymphedema with a better prediction of treatment outcome and decision point for additional medical/surgical therapy

Skin care regimen (hygiene, skin care techniques and simple exercises that encourage

lymph drainage )126


Cohort study

ADLA

DLQI

To analyse the impact on the quality of life that education and introduction of a designated nurse had on lymphoedema patients in a community that was endemic for lymphatic

Filariasis

Manual lymphatic massage, remedial exercises, multilayered inelastic compression bandaging, meticulous skin care and education of parents 127

1

Case report


To find the effect of physipotherapy exercise in reducing the volume in baby with congenital lymphedema

Radiotherapy and a mean of 12.6 sessions of daily CDP128

44(27 had cervical cancer, 9

endometrial cancer, and 8 ovarian cancer)

Retrospective study

Volume

The interval from pelvic cancer treatment to lower limb lymphoedema development was 63.4 months

Traditional medicine

The literature search for morbidity management of lymphoedema was retrieved from AYUSH treatments listed in Govt. of India AYUSH portal. This search yielded 46 studies. 16 were relevant for morbidity control. We have classified these interventions as

  1. Ayurveda(11 studies)

  2. Homeopathy(2 studies)

  3. Siddha(3 studies )





  1. Table below lists all studies under the above classification


    1. Ayurvedic interventions


    SI. No

    Intervention

    Number of patients

    Method

    Outcome

    Comments


    Therapeutic effect of AYUSH-64

    Six randomly selected villages around Bhubaneswar covering a population of 1936 for microfilaraemia

    To evaluate the efficacy of Ayush-64

    Elimination of microfilaria in peripheral smear

    The compound Ayush-64 appears to be moderately effective

    Organic solvent extracts of seed of Ricinus communis

    In vitro study

    Antifilarial activity of the methanol extract revealed a dose dependent positive response as evident from induction of death in the developmental stages of a metazoan filarial parasite Brugia malayi

    Anti microfilaria activity

    The finding of the present study revealed that Ricinus communis possesses 40%, 70% and 90% a antifilarial activity. Ricinus communis can be a potential source of agents that can be used during chronic manifestation of lymphatic filariasis in human beings but also for blocking embryogenesis in filarial parasites which in turn can potentially affect their transmission and survival in host communities

    Kanchanara Guggulu and Gokshuradi guggulu

    50 patients of chronic LF

    Not available

    Not available

    The effect of the treatment has been obvious within a few days and most of the patients have been completely, relieved within a period of 2-4 weeks

    Lakshana samuchuchaya in shlipada

    120 patients

    Clinical study

    Not available

    Study looked into ayurvedic clinical features

    Sudarashana Gana vati AYUSH-55 and Punarnavarista


    A combination of Ayurvedic compound formulations comprising of Sudarsana Ghana Vati, Ayush-55 and Punarnavarista was tried in the manifest cases of Slipada with more than one year duration

    Not available


    Kanchanara guggulu and Gokshuradi guggulu

    97 Patients

    To evaluate the therapeutic efficacy of drugs Kanchanara guggulu and Gokshuradi guggulu

    ADLA

    Lymphangitis

    Eosinophil count


    60.82% showed significant response

    Kuberaksha patra churna ,Vriddhadaru mula churna and Kandughna thaila

    133 patients were included in three groups (45 in Gr.I, 45 in Gr.II and 43 in Gr.III) and 120 patients completed the study (40 in each group)

    To evaluate the effect of drugs in filariasis

    Lymphangitis

    Eosinophil count

    QOL

    Study claims that all grade of lymphoedema respond equally well

    Triphala pippali punarnava and sleepadari rasa

    122 Patients

    To evaluate the therapeutic efficacy of drugs Triphala Pippali Punarnava and Sleepadari rasa in the management of Slipada

    Lymphadenitis

    Lymphangitis

    QOL

    Eosinophil count



    By the statistical analysis the mean difference in relief on each parameter was found highly significant (P<0.001) except on Eosinophila (P>0.10)

    Nithyanadarasa , Bhunimba vati and Sarshapalepa prepared with gomutra externally

    32 Patients

    Observation on the reduction of sotha in cases of slipada

    reduction of symptoms

    It is observed that the response to treatment was good in Kapha dominent cases of slipada

    Kancahanara guggulu

    And gokshuradi guggulu

    97 patients

    To evaluate the therapeutic efficacy of drugs Kanchanara guggulu and Gokshuradi guggulu in the management of Slipada

    Lymphadenitis

    Lymphangitis

    lymph oedema

    pain

    tenderness,

    heaviness

    fever

    rigor

    74.65% relief was found in all parameters

    Sudarasana Ghana vati,Arogya vardhini and Punarnavaarista

    30 patients

    To find the shothahara effect of the combination of sudarshana gana vati arogya vardhina and punarnavaarista in chronic caese odf slipada


    swelling

    One month of treatment there was marked reduction in swelling

    Homeopathy intervention

    SI. No

    Intervention

    Number of patients

    Method

    Outcome

    Comments


    Rus tox, Bryonia alba, Sulphur, Apis mellifica, Natrum muriaticum, Pulsatilla ,Rhododendron ,

    Silicea , Thuja 129

    973

    Not available

    Not available

    CCRH after years of extensive work on filariasis has confirmed the efficacy of Rhus tox, Bryonia alba and Apis mellifica in this disease and these three drugs have been recommended to be included in the National Control Programme of Filariasis

    Apis mel, Bryonia alba , Natrum muriaticum ,

    Pulsatilla ,

    Rhododendron ,

    Rhus toxicodendron and Sulphur 130

    11445

    All patients were subjected to night blood examination for presence or absence of microfilaria in peripheral blood. Medicines were prescribed according to the individual totality of the patient.

    ADLA

    Girth

    Volume

    A group of most useful medicines in managing filariasis were evolved and their most reliable indications were deduced in this study. Most useful potencies of medicines are 30 and 200.

  2. Siddha intervention

SI. No

Intervention

Number of patients

Method

Outcome

Comments


Filacid131

Over 10,000 patients

Not available

Antifilarial active test

In-vitro investigation of the drug has shown it macro-filaricidal at 500 ug/ ml with motality suppressed within 4h at this concentration. it is also suggested to include this drug (filacid) in the primary health care programmes particularly in the Afro-Asian countries including India to combat filariasis amongst masses affected with this disease

Two coded unani drug combinations with and without Munzij and Mushil therapy132

36

Not available

Not available

According to the clinical and pathological findings both the combinations were observed to possess significant efficacy except in the case of filarial oedema which reduced minimally, showing that these combinations are less effective in the chronic cases

Two coded unani formulations, UNIM-268 and UNIM-269 with and without Munzij and Mushil (MM) therapy133

41

Not available

Not available

better response has been obtained in the cases having chronicity of lesser duration



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59 Mihara M, Hayashi Y, Murai N, Moriguchi H, Iida T, Hara H, Todokoro T, Narushima M, Uchida G, Koshima I. Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography.Clin Radiol. 2011 Aug;66(8):715-9. doi: 10.1016/j.crad.2011.03.004. Epub 2011 Apr 23.


60 Espinosa-de-Los-Monteros A, Hinojosa CA, Abarca L, Iglesias M. Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox. J Vasc Surg. 2009 Jan;49(1):222-4. doi: 10.1016/j.jvs.2008.07.073.


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