| Summary: | The main aim of the study is to evaluate the effectiveness of sequential graduated intermittent pneumatic compression (SGIPC) therapy of lower limbs edema, regardless of its etiology. A retrospective observational study is conducted to determine the effectiveness of a regimen of sequential gradient SGIPC in treating edema of lower limbs. The study is carried out on 90 patients affected by different stages of edema and evaluated at a Wound Care Clinic for one month. Medical records data have been collected after the first, the third, and the fifth hour-long treatment session. The inclusion criteria are: (1) presence of edema to one limb, at least, regardless of etiology, (2) presence of both pain and feeling of heaviness (or tiredness) of the limb, (3) non-use of bandages or elastic stocking/knee socks, and (4) availability of complete data about the edema size monitoring. The exclusion criteria are: (1) presence of infected wounds, (2) severe arteriosclerosis or other ischemic vascular diseases, (3) severe congestive cardiac failure, (4) known or suspected acute deep vein thrombosis (DVT), (5) thrombophlebitis or Pulmonary Embolism (PE), and (6) hypertension (Systolic Pressure greater than 170mmHg). The following parameters are considered as grade of improvement: the decrease of the limb circumference in at least two measurement points between the foot, ankle, and calf; the disappearance of at least one of the symptoms of pain and feeling of heaviness of the limb; improved mobility. A Flowtron ACS 900 system is used, for the treatment, consisting of a pump, connected to two (calf and thigh) brace with individual tubes, applying a pneumatic compression, graduated in the air chamber, with sequential cycle in three compartments (one at the calf level and two at the thigh level), at a pressure of 45mmHg, with inflation cycles intermittent alternating. Inflation time 12s, time of deflation 48s. In addition, braces corresponding to limb size have been used (automatically recognized by the system).
In a sample of 90 patients (95.6% women and 4.4% men) with edema of the lower limbs (37.8% at stage 1, 43.3% at stage 2, 15.6% at stage 3, and 3.3% at stage 4), a successful treatment has been found, from the first session. A circumference decrease greater than 3mm in at least two measuring points between the foot, ankle, and calf, of 77.8% after the first session, 90% after the third session, 90% after the fifth session, on average for both limbs. The disappearance of pain at the end of the session has been found in 85.6% of cases after the first session and 100% after the third and fifth, respectively. The feeling of heaviness of the limb has disappeared in 100% of cases at the end of the sessions. For the stages 3 and 4, it is generally observed an improvement of mobility in 58.9% of cases at the end of the first session and equal to 100% after the third and fifth session. A good compliance in patients who have rejected the manual lymph drainage has been found. Moreover, a good applicability has been found in patients with critical issues such as dermatoporosis and capillary fragility, and bariatric patients. In general, the patients have underestimated the edema, specifically only 21% of patients at a stage greater or equal to 2 have recognized the edema as a clinical problem.
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