Fluid Distribution: Response to Intermittent Pneumatic Compression in People With and Without Primary Lymphedema

Background: Current understanding of changes in fluid distribution in response to the application of compression in primary lymphedema (PLE) is limited. This study measured fluid distribution before and after one application of standardized intermittent pneumatic compression (IPC) in the lower limbs of people with PLE, compared with those without lymphedema. High-frequency ultrasound (HFU) was used to measure dermal fluid, bioimpedance to measure segmental fluid, and percent water content (PWC) to measure fluid at specific anatomical points. Methods and Results: Fifteen people with PLE aged 11-40 years were matched for age, gender, and ethnicity to a person without lymphedema (NLE). PWC and HFU measures (low echogenic pixels) were taken bilaterally on the posterior leg and dorsum of the foot. Segmental bioimpedance (Extracellular Fluid/Intracellular Fluid, ECF/ICF) was measured in the foot, leg, and lower limb. Differences between groups, using the affected leg of unilateral and the more affected leg of bilateral PLE, were analyzed using the mixed ANOVA. There was significantly less ECF/ICF in the leg of NLE (p = 0.005) and PLE (p = 0.022) following IPC, and in the whole treated lower limb of NLE (p = 0.013), but no change in the treated limb of PLE. In contrast, the untreated limb showed significantly higher ECF/ICF in PLE (p = 0.040), a change not seen in NLE. Conclusions: The lack of response to compression in the foot, commonly affected in PLE, and the increase in fluid in the untreated PLE limb, indicates the need for further investigation of the effect of compression on fluid distribution in PLE.