(PI-025) Modification of Manual Lymphatic Drainage based on ICG Lymphography

Anna Nadziejko, MSc, PT – Diagnostic Center for Lymphatic and Venous Flow Disorders

Introduction:

ICG lymphography is a diagnostic method for observation of vascular function in the superficial lymphatic system, tissue fluid retention and extravascular drainage pathways. Lymphography provides a information enabling diagnosis and planning of personalized surgical or conservative treatment.

Manual lymphatic drainage (MLD) is a therapy for treatment of edema and chronic wounds associated with lymphatic, venous, or mixed insufficiency. MLD is a demanding therapy whose effectiveness depends on the therapist's adroitness.

Methods: MMLD was developed based on long-term experience in ICG lymphography. MMLD is based on determining the direction and location of lymphosomes, vascular and extravascular flow, and the strength and pace of therapist’s maneuvers. The ICG examination results in so-called lymphomapping for therapeutic purposes, along with a dedicated therapeutic protocol for MMLD. The effectiveness of MMLD compared to MLD performed according to E. Vodder's was assessed on a qualified group of 40 patients. All patients were diagnosed with unilateral leg edema, grade 2 according to the ISL, confirmed by a harmonized tonometric pitting test. All qualified patients were randomly divided into two groups of 20. All patients in the study group underwent ICG lymphography (*PDE-GEN3, Hamamatsu, Japan) with lymphomapping. In both groups, 3D body scanning (*BodyLux 3D, ViALUX, Germany) was performed immediately before and after manual drainage to objectively assess limb circumference and volume before and after treatment. The duration of manual therapy was measured for each patient in both groups

Results: The analysis of limb volume before and after manual therapy showed that the group with MMLD achieved a 4-times better reduction of volume, comparing to the the control group with classic MLD. The mean time required to perform MMLD was 2-times shorter comparing to classic MLD

Discussion: MMLD shows significantly higher efficacy than MLD while significantly shortening the time needed for therapy. ICG lymphography sholud be considered as an effective tool for personalizing and optimizing conservative anti-congestive therapy