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Updated: Oct 21, 2025
A Murine Tail Lymphedema Model
Published on: February 10, 2021
Treatment Outcomes of Manual Lymphatic Drainage in Pediatric Lymphedema
Kausar Ali1, Rami P Dibbs1, Catherine Dougherty2
1Division of Plastic Surgery, Baylor College of Medicine, Houston, TX.
Insights
Manual lymphatic drainage (MLD) effectively reduced limb swelling and improved function in pediatric patients with lymphatic anomalies. This noninvasive therapy also alleviated pain, offering a promising treatment for children with lymphedema.
Area of Science:
- Pediatric Medicine
- Vascular Surgery
- Dermatology
Background:
- Pediatric lymphedema causes debilitating limb swelling, fibrosis, and functional impairment.
- Manual lymphatic drainage (MLD) is a noninvasive decongestive therapy to reroute lymphatic flow.
- Outcomes of MLD in pediatric patients with lymphatic anomalies were previously unstudied.
Purpose of the Study:
- To evaluate the effectiveness of decongestive therapy involving MLD in pediatric patients.
- To measure treatment progress and functional outcomes in children with complex lymphatic anomalies.
Main Methods:
- Retrospective study of 8 pediatric patients with lymphatic anomalies who received MLD.
- Measured limb circumference, functional performance (Canadian Occupational Performance Measurement), and pain scores.
- Data collected from 2015 to 2017 at a single institution.
Main Results:
- Five of 8 patients showed lymphedema reduction, with average girth decreases of 8.2% (lower extremities), 3.0% (upper extremities), and 7.4% (truncal regions).
- Unilateral cases demonstrated a 25.6% average decrease in limb circumference difference.
- Four patients reported a 30% average improvement in daily task performance, and three achieved complete pain resolution.
Conclusions:
- Manual lymphatic drainage (MLD) is a reliable noninvasive method for decongestion and pain relief in children.
- MLD can help delay lymphedema-associated fibrosis and long-term disability.
- This therapy shows promise for managing complex lymphatic malformations in pediatric patients.
Background:
Pediatric lymphedema can result in irreversible, debilitating limb swelling, tissue fibrosis, skin ulcers, infection, and impaired limb function in children at an early age. Manual lymphatic drainage (MLD) is a noninvasive technique, which is a part of intensive decongestive therapy to reroute lymphatic flow to healthy channels used to manage lymphedema. Outcomes of this treatment option in children have not been studied. We evaluated the effect of decongestive therapy involving MLD in pediatric patients with complex lymphatic anomalies by measuring treatment progress and functional outcomes via changes in limb circumference, limb functionality, dexterity, skin quality, and pain.
Methods:
A single-institution retrospective study on a cohort of 8 pediatric patients with lymphatic anomalies who completed a course of MLD was conducted from 2015 to 2017 to investigate the role MLD plays in their lymphedema reduction. Pain scores were measured on a scale of 0-10, with 0 being no pain and 10 being the worst pain imaginable. The functional performance was measured by the Canadian Occupational Performance Measurement questionnaire.
Results:
Among all patients, there were 4 cases affecting the upper extremities, 4 affecting the lower extremities, and 3 affecting the truncal region. Five of 8 patients demonstrated a reduction in lymphedema with an average girth reduction of 8.2% in the lower extremities, 3.0% in the upper extremities, and 7.4% in the truncal regions. In unilateral cases, the difference in limb circumference between the affected and normal extremity decreased by an average of 25.6%. Four patients completed the Canadian Occupational Performance Measurement questionnaire with an average improvement of 30% in daily task performance. Three patients reported complete resolution of pain.
Conclusions:
MLD can be used as a reliable noninvasive method for decongestion and analgesia to delay the onset of lymphedema-associated fibrosis and long-term disability in children with complex lymphatic malformations.
