Abstract
Objective: To evaluate the application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis (LVA) combined with liposuction in patients with lower limb lymphedema. Methods: This study was a historical control study. From June 2021 to January 2023, a total of 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy without application of lymph pads at the Department of Burn, Plastic and Cosmetic Surgery of Xi'an Central Hospital of Xi'an Jiaotong University (hereinafter referred to as our department) were included as control group. There were 2 males and 21 females in this group, with the age of 58±10 years. From February 2023 to January 2024, another 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy with additional application of lymph pads at our department were included as lymph pad group. There were 3 males and 20 females in this group, with the age of 59±11 years. Before treatment and at 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint of the affected limbs were measured, and the total score of lymphedema functioning, disability and health questionnaire for lower limb lymphedema (Lymph-ICF-LL) and score of lower limb function in Lymph-ICF-LL were recorded in patients in the two groups. Results: At 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint in patients in lymph pad group were (22.9±1.7), (26±3), (44±8) cm and (20.7±1.7), (25±3), (42±6) cm, respectively, which were significantly smaller than (24.3±2.3), (29±4), (49±10) cm and (23.9±2.2), (29±4), (48±12) cm in control group (with t values of 2.18, 2.29, 2.09, and 5.84, 3.92, 2.31, respectively, P<0.05), and the mean differences (95% confidence intervals) between the two groups were 1.3 (0.1 to 2.5), 2 (0 to 4), 5 (0 to 10) cm and 3.3 (2.2 to 4.5), 4 (2 to 6), 6 (1 to 12) cm, respectively. There were no statistically significant differences in the total Lymph-ICF-LL scores of the affected limbs between the two groups of patients before treatment and at 6 and 12 months of treatment (P>0.05). At 6 and 12 months of treatment, the lower limb function scores in Lymph-ICF-LL of the affected limbs in lymph pad group of patients were significantly lower than those in control group (with t values of 2.24 and 2.44, respectively, P<0.05), and the mean differences (95% confidence intervals) between the two groups were 5 (1 to 9) and 5 (1 to 9) cm, respectively. Conclusions: During complete decongestive therapy following LVA combined with liposuction, the application of lymph pads can significantly reduce the circumference of the dorsum of the foot, ankle joint, and knee joint in patients with lower limb lymphedema, and also improve their lower limb function.