K. Ali1, C. Dougherty2, R. Maricevich1,2, I. Iacobas1,2 1Baylor College Of Medicine,Houston, TX, USA 2Texas Children’s Hospital,Houston, TX, USA
Introduction:
Generalized pediatric lymphedema is primarily due to congenital malformations or lymphatic dysplasia. Manual lymphatic drainage (MLD) via the Vodder technique is a popular therapeutic modality that incorporates superficial and deep massage to soften soft tissue, increase lymphatic flow, and improve functional limb performance. However, there is sparse literature discussing MLD outcomes in pediatric patients with lymphedema. Our purpose is to quantitatively measure the effect of MLD on pediatric lymphedema based on differences in girth, weight, and functional performance before and after therapy.
Methods:
Retrospective chart review was performed on pediatric patients with primary lymphedema who underwent a 1-month course of MLD between 2015-2017. Data collected included weight, limb girth, extremity strength, pain scores, and functional limb performance before and after MLD. Patients with other causes of edema (i.e. heart failure, renal failure) were excluded. Data statistics were used to quantify the reductive effect of MLD.
Results:
10 children with primary lymphedema who completed the MLD course were identified (median age 8 years, range 0.4-18 years). Immediately following MLD, weight reduced by 2-19%, and limb girth reduced by 4-27% in lower extremities, 0-10% in upper extremities, and 5-22% in truncal regions among the patients. More pronounced reduction was noted in the distal extremities compared to proximal extremities after therapy. Validated functional questionnaires showed at least 50-60% improvement in limb performance in half of the patients. Clinically, pain scores improved by 80-100%, soft tissue was softened with improved skin quality, and range of motion of affected limbs improved as noted during physical therapy sessions. Two patients had minimal improvement in lymphedema girth and range of motion after MLD and subsequently underwent sclerotherapy and lymphovenous bypass surgery.
Conclusion:
Manual lymphatic drainage is not a cure, but does improve reduction in the amount of extremity lymphedema with consistent usage. Noticeable improvements include decreased limb girth particularly of distal extremities, softening of skin and tissue, and favorable patient-reported functional outcomes. These findings suggest that MLD can be a reliable therapeutic modality in pediatric lymphedema until more permanent solutions are available. Large, prospective studies are needed to validate these results.