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Clinical Research

(CR-063) The effect of IPC compression on tissue elasticity in lower limbs lymphedema measured in USG elastography.

Thursday, May 16, 2024

7:30 PM – 8:30 PM East Coast USA Time

Introduction: In lymphedema of the lower limb, regardless of etiology, we have fluid accumulation in the tissue and overgrowth and remodeling of tissue. Both factors influence tissue biophysical properties and tissue stiffness. The main goal of conservative treatment is the reduction of volume and weight of edematous limbs and the prevention and reduction of tissue fibrosis and stiffness. Our previous studies using skin and deep tissue tonometer prove the effectiveness of IPC on increasing tissue elasticity in lymphedematous limbs.
We aimed to investigate the usefulness of USG elastography in estimating changes in skin and subcutaneous tissue elasticity after IPC compression and correlate them with durometry, tonometry, and skin water concentration.

Methods: Twenty patients with lower limb lymphedema stage I-III of different etiology were investigated. The lymphatic origin of limb swelling was proven in ICG lymphography. In the selected limb region (10x 5 cm), on the inner part of the middle calf, we did USG examination (SE, SWE) (Canon APLIO i800) and), durometry (SkinFibrometer; Delfin Technologies Ltd.), tonometry (Wagner, Seattle, WA), skin water concentration (LympScanner; Delfin Technologies Ltd.). Then IPC (Bio Compression system) was applied for 45 min with the pressure of 80-100 mmHg depending on tissue stiffness. After the session with IPC, all measurements were repeated.

Results: After 45-minute sessions with IPC, we observed a reduction in skin water concentration by 18.0 %, skin stiffness by 23.2 %, and subcutaneous tissue stiffness by 30.4 %. We also observed the changes in strain ratio and elasticity (kPa). Before IPC, the strain ratio and elasticity values were different at different tissue levels: dermis, upper, middle, and lower levels of subcutis, and they change differently at different tissue levels.

Discussion:

Conclusions. IPC changes the biophysical properties of tissue and reduces tissue stiffness. Both types of USG elastography can be used to investigate changes in tissue elasticity after IPC. However, correlation with other methods measuring skin and subcutaneous tissue can help to understand the changes that develop in tissue under the influence of IPC.