The effect of prolonged complex decongestive therapy for lower limb secondary lymphedema

OBJECTIVE To clarify the effect of prolonged complex decongestive therapy (CDT) on limb volume in patients with lower limb lymphedema (LLL).

METHODS We reviewed patients who first visited our clinic for cancer-related LLL between April 2009 and March 2015 and continued CDT at our clinic for 7 years or longer. At 6- to 12-month intervals, limb volume was calculated from tape measurements, and ultrasonography was performed to evaluate changes in the skin and subcutaneous tissue conditions.

RESULTS In 52 patients (68 lower limbs) who were on CDT for median 11.2 years, 54% maintained reduced limb volume, while limb volume increased in 46% of patients compared with their initial visits. An increase in circumference was mainly observed in the calf area, where the subcutaneous echo-free space (edema) increased. In multivariate analysis, relevant factors associated with the increase in limb volume were an increase in body mass index (BMI) (odds ratio 1.73 [95% confidence interval 1.15-2.93]), the use of compression devices for fewer than 5 days per week (odds ratio 4.57 [95% CI 1.06-23.53]), and the use of compression devices with interface pressure lower than 20 mmHg (odds ratio 36.47 [95% CI 3.42-1061.90]).

CONCLUSIONS During prolonged CDT, limb volume increased in 46% of limbs with LLL, which was associated with an increase in edema, particularly in the calf area. The factors associated with increased limb volume were the increase in BMI and the use of compression devices < 5 days/week and with interface pressure < 20 mmHg.