Case 79: Successful Treatment of Postoperative Lymphedema

This 79 year old woman was referred with complaints of pain and swelling in her left leg. She had had a right colectomy two months earlier for adenocarcinoma of the cecum. Postoperative complications included possible left iliofemoral arterial obstruction, an abdominal abscess and a possible pulmonary embolus. A phleborheogram and a lung scan were normal. She was readmitted with shortness of breath and leg swelling. Diuretics and anticoagulants appeared not to affect the leg swelling. Her arterial Doppler studies were normal. Venous Doppler testing was normal except for a lack of respiratory variation in the lower leg. She was referred for boot therapy which successfully reduced her leg swelling and discomfort. Within a few weeks of discharge, her leg again swelled and became painful. Her walking became limited to 25-30 feet. Her doctor again referred her for outpatient boot therapy.

Here, midway through her course of outpatient therapy, the circumference of her left calf was still 7cm greater than the right calf.

Over four months, she was given 24 Long-Boot treatments successfully increasing her walking distance to 150-200 feet and reducing the circumference of her calf to 15 inches. Her leg did well until her death the next year.

Comments: This lady is included to remind the reader that we can successfully treat lymphedema with the Circulator Boot Systems. In her case, the "bad" leg was never reduced to the size of the "good" leg (13 1/4 inches). Her pain was relieved and her walking distance increased. Further success in reducing her leg size might have been accomplished if she had been put to bed rest and elevated the limb. The Circulator Boot, of course, differs from other boots more commonly used for the treatment of lymphedema in being synchronized with the heartbeat, delivering a number of compressions per minute equal to the pulse rate, being timed to support heart function, being timed to avoid blocking arterial inflow into the leg, being flexible in its application so that a chosen segment of the leg can be treated, and likely stimulating higher levels of circulating fibrinolysins. With a pulse of 80, for example this lady might receive 3200 compressions over 40 minutes while a common lymphedema boot timed to compress the leg perhaps over 20-40 seconds every two to three minutes might deliver 15 to 20 compressions.