Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage—a randomized controlled trial

Abstract

Purpose Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery? Methods A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care. Results and conclusion NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p < 0.05). Conclusion Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.

Level I of evidence does not support manual lymphatic drainage for total knee arthroplasty: a meta-analysis

“…The efficacy of MLD in musculoskeletal medicine is controversial [42][43][44][45][46] . After orthopaedic surgery, tissue swelling may be associated with a longer recovery and increased pain, limited mobility, reduced function, and interference with the wound healing process 47,48 . The most important limitation on the clinical efficacy of MLD is the limited evidence available in the current literature.…”

Avaliação Temporal Do Edema Pós-Operatório De Cirurgia Plástica Eletiva Em Um Serviço Privado Do Oeste Do Paraná

“…Diante disso, é possível concluir que à nível abdominal, as cirurgias de abdominoplastia, lipoaspiração e ambas as técnicas combinadas, são procedimentos que geram mais edema do que as cirurgias de mama. Isso provavelmente se deve ao fato de que as cirurgias abdominais removem mais tecidos dos pacientes e quanto mais traumática a cirurgia mais edema ela vai gerar, pois causa rupturas aos vasos linfáticos (WEBER et al, 2023).…”