Milking effect on lymphoedema fore-arm: manual versus pneumatic drainages

Mr Serge THEYSa, Mr Thomas HENNEQUARTa, Mrs Maria Encarnation AGUILAR FERRANDIZb, Prof Thierry DELTOMBEa

a CHU Dinant Godinne, b Univ Granada; Spain

INTRODUCTION: Milking effect is widely search in manual drainage technic. Since 1993, some pumps can work in a similar retrograde mode.

OBJECTIVE: Our aim was to compare the effects of three light retrograde drainage options: 2 pneumatic and one manual one’s.

METHOD : We used a fragmentation program with a seven-compartment i-Press® 10th serial (Mazet Med™, Fr); with a Lymphassist® program with a 12-compartment Hydroven12® (Flowtron™, GB); and a manual drainage are successively and randomly carried out on 9 women (71 years old) with an old (14 years) persistent upper limb lymphoedema that appeared 7 years after radio-surgical treatment against breast cancer. All volume variations are recorded continuously with a plethysmograph (JSI™, SU4). Mercury gauges are fitted 4 inches below the elbow. The protocol of pneumatic drainages consisted of a standardised retrograde approach with constant pressure (40 mm Hg) (without regressive pressure) at a single to double-level of compression.

RESULTS By use of Kruskal and Wallis, one-way ANOVA on ranks, the effect of arm drainage on the fore-arm was +0.04 ml/100 mloed (med 0 [+1 to -1] when the drainage was applied manually, +0.07 ml/100 mloed (med 0 [0 to +1.25] using Lymphassist® and -0.17 ml/100 mloed (med 0 [0 to -1.2] using the iPress pneumatic pump. When drainage takes up the elbow and the fore-arm, at 4 inch below the elbow, the results were respectively -0.64 ml/100 mloed (med 0[0 to - 2], +0.07 ml/100 mloed (med 0 [0 to -1.25] and 0.67 ml/100 mloed (med -0.53 [0 to -1]

CONCLUSION Except in two cases, whatever the technique used, there was no milking effect. On the contrary, the forearm has taken more volume with DM and Lymphassist ®. It is necessary that drainage arrives at the elbow to observe in some cases a milking effect. This was only observed with the DM or the iPress ®.

Keywords : upper limb lymphedema ; manual drainage ; pneumatic pressotherapy ; phlethysmography