ALBERTA HERITAGE FOUNDATION FOR MEDICAL RESEARCH Technote

s of 54 articles were reviewed. Three studies that specifically investigated treatment of primary and secondary lymphedema were analyzed (1, 2, 3). They were prospective clinical series and were neither randomized nor controlled. Bergen, et al. (1) studied thirty-five patients to determine the optimal method of mechanical compression for both primary and secondary lymphedema. Each limb was treated by three types of compression devices: a single cell pump composed of one bladder inflated to 50 mmHg around the edematous area, a three compartment pump inflated to 50 mmHg, and a ten-cell gradient pressure pump inflated to 30 mmHg proximally and 80 mmHg distally. Displacement measurements were used to compare limb volume pretreatment and immediately after the 2 hour compression therapy. The measurement post-treatment revealed negligible change with a one-cell compression pump, and in some cases the volume of the limb increased. The three-compartment device was marginally better, but the multicompartment device was reported to have effected a significant decrease in edema over the 2 hour treatment for patients with primary or secondary lymphedema. Categorizing the participants into three groups: primary lymphedema, secondary lymphedema without radiation, and secondary lymphedema with radiation therapy, the researchers proposed that there is no difference in results amongst these groups. Difficulties with interpreting these data lie in the study design. It is unclear what time period elapsed between each of the treatments, nor is it clear what area of the limb was covered by each compression device. There is a heterogeneity in the duration, severity, and type of lymphedema, age range of the participants, and the influence from previous therapy. The study compares each limb to itself preand post-treatment using three different compression pumps. However, there is no evaluation of the effect of the order of treatment nor of the time between treatments. Pappas et al. (2) performed a case series non-randomized follow-up study on the long-term effects of sequential high-pressure intermittent pneumatic compression (SIPC) therapy followed by application of elastic stockings in 49 patients with primary and secondary lymphedema. Most of the participants had undergone some form of treatment prior to the study: forty were wearing elastic stockings, five used unicompartmental compression device, two had had surgery. A multicompartmental sleeve of 9 to 12 cells was used with a maximum compression per cycle of 110 mmHg for 20 seconds distally and 80 mmHg for 2 seconds proximally. This was applied for 6 8 hours over a 2 3 day hospital stay. Custom fitted compression stockings of 40 mmHg were then applied to the limb at the post treatment girth.