Conservative treatment Compression therapy in PLE

Structure of the module

1. Aim
2. Summary
3. Learning outcomes
4. 1.pre-module test 
5. 2.case reports
6. 3.case scenarios 
7. Controversies
8. Consensus – Expert opinion
9. Follow-up
10. Red flags
11. Videos 
12. References 
13. Future researches
14. Post-module test
15. Your questions

1. Aim

Compression therapy

• Content: This module is informative and based on scientific evidence
• Target population: Health professionals (HP)
• Referral: Specialized centers (please see the map)
• Patient group: Babies and children with lymphedema. It should be noted that adapted compression therapy is needed in according to the age, specific needs, and growth rate
• Follow-up: Regularly and systematic

2. Summary 

  Compression therapy in pediatric lymphedema

Summary

•Lymphedema due to a defect in the lymphatic system seen in the childhood is named as pediatric lymphedema (PLE)

•Primary PLE may be one symptom or syndromic and mainly affects the lower limbs, or, sometimes external genitalia, and rarely upper limbs

•Girls are more frequently affected than boys

•As in adults, secondary lymphedema may also be seen after trauma, cancer treatment, and infections in children

_{1.Gordon K, J Med Genet. 2020 Oct;57(10):653-659.} 

_{2.Executive Committee of the International Society of Lymphology, Lymphology. 2023;56(4):133-151.} 

_{3. https://www.lympho.org/uploads/files/files/Care-of-Children-with-Lymphoedema.pdf}

•According to St George’s classification primary PLE is mainly divided into 5 groups as seen in figure 1 (1)

1. The syndromes (lymphedema is not the main feature)
2. Lymphedema with systemic or visceral involvement (fetal hydrops, pleural and pericardial effusions, ascites, intestinal or pulmonary lymphangiectasia)
3. The congenital onset (<1.0 year) 
4. The late onset (≥1.0 year)
5. The vascular and lymphatic malformations

_{1.Gordon K, J Med Genet. 2020 Oct;57(10):653-659.} 

The main aims of lymphedema treatment are (2) :

•to decrease lymphedema volume

•to stabilize this volume 

•to prevent complications 

•to improve the functioning and quality of life of the patient 

•Lymphedema treatment may be divided as

1. Non-surgical treatment 
2. Surgical treatment in selected cases

_{2. Executive Committee of the International Society of Lymphology. The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The ISL. Lymphology. 2023;56(4):133-151.}

PLE management includes:

•Early referral to specialized centers 

•Multidisciplinary, individualized care plans

•Emphasis on education for parents and healthcare professionals

•Life-long and growth-related follow-up 

•Compression therapy modifications

•The support in school life and sports activities

•Addressing psychosocial impacts proactively

•The literature on treating primary PLE is very limited, and largely based on practices for secondary PLE (4) 

•The main treatment in adult lymphedema is complete decongestive therapy (CDT), including 

1. meticulous skin care 
2. manual lymphatic drainage 
3. compression therapy 
4. remedial exercises 

•This treatment may be appropriate for children, also

_{4. Senger JB. Medicina (Kaunas). 2023 May 6;59(5):894.} 

•The skin of babies and children is very soft, sensitive, and fragile

•Therefore, compression therapy is planned with close follow-up

•Compression therapy may be postponed until walking age 

•Compression bandaging may be applied for a few hours at the beginning of compression therapy

•Compression stockings may be changed more frequently due to increasing size of limbs

•Parental caregiving may be tiresome and needs support in the long term

•Compression therapy products may be applied to the lymphedema areas and consist of

1.Compression bandages

2.Medical compression stockings or elastic compression stockings or hosiery : ■ Round knit or standard ■ Flat knit

3.Adjustable compression wraps

4.Compression pumps

  Should not be applied to open wounds

Learning Outcomes

  Compression therapy

•Assessment of learning outcomes consists of 

1. Pre module test – completion is necessary for module entrance
2. Case reports
3. Case scenarios

Pre-module test

Compression therapy

Module Assessment Questions

•Please answer questions before the module

•“Certificate of Completion” at the end of the module will be provided if needed