PATHWAYS OF LYMPH AND TISSUE FLUID FLOW DURING INTERMITTENT PNEUMATIC MASSAGE OF LOWER LIMBS WITH OBSTRUCTIVE LYMPHEDEMA

Abstract

Questions remain on the use of sequentialpneumatic compression including where doesthe fluid flow to and whether fluid can bemoved to the non-swollen tissues of thehypogastrium and gluteal region? Duringpneumatic massage of the limb, we studiedpathways of lymph and mobile tissue fluidflow using lymphoscintigraphy: a) from thecalf and thigh across the inguinal region tothe healthy non-swollen tissues of thehypogastrium and b) in the hypogastrium tothe lateral and upper abdominal quadrants.To examine if there was effective fluid flowduring pneumatic massage, plethysmographicflow measurements were also carried out. Wedemonstrated that: (i) pneumatic compressionmoved isotope in lymph remaining infunctioning lymphatics and in tissue fluid inthe interstitial space toward the inguinalregion and femoral channel, (ii) there was noisotope crossing the inguinal crease or movingto the gluteal area, and (iii) isotope injectedintradermally in the hypogastrium did notspread during manual massage to the upperand contralateral abdominal quadrants. Inconclusion, intermittent pneumatic compressionis effective in pushing mobile tissue fluidand relocating large fluid volumes toward thegroin. However, the question that still remainsis how to facilitate further flow toward thenon-swollen tissues and thereby increase localabsorption of fluid.