Why Compression Garments And What is the Goal of Compression Therapy in Lipedema?
1. Why Compression Garments?
There are many reasons to consider using compression garments. The underlying problem with all lymph disorder is problems circulating lymph back to the venous system. For individuals who have lipedema, lymphedema or lipo-lymphedema, compression garments are often used to assist the lymph circulation by increasing the pressure in the tissue propel lymph fluid through the body. Lymphedema causes excess fluid to become trapped in the extremities, especially on the legs, and the compression garments put pressure on the skin and veins, help them to clear lymph and decongest.
Besides improvement to lymphatic flow, there is some debate about compression garments’ benefits related to fat disorders, such as lipedema. Most people with lipedema( 脂肪水腫 ) the pain tenderness are worsened by swelling and activities such standing or having the leg or hand dependent that promote local swelling. Compression garments can help reduce pain and heaviness felt in the limbs from fat disorder such as lipedema by decreasing swelling in the fat and throughout the limb. Also compression potentially reduces the rate at which the fat cells grow and help to prevent fat disorders from progressing to more serous stages. In other words, compression can be one of the best treatments for lipo-lymphedema or fat causes by lymphatic diseases.
2. The Goal of Compression Therapy in Lipedema
The goal of compression therapy in lipedema is:
Compression has been shown to reduce discomfort, aching and limb heaviness as well as supporting the health of the tissue.
Compression helps to streamline uneven or distorted limb shape and improve movement.
Compression helps to reduce edema by reducing the interstitial fluid formation and encourage venous and lymphatic return in lipedema. (Hardy, 2016)
All three goals are critical for the management of lipedema. Compression is the cornerstone on which all other treatments for lipedema are built upon as it is the only treatment that has been shown to benefit every patient with lipedema. Studies have shown medical grade graduated compression is the most universally applied effective treatment for reliving limb heaviness, tenderness and leg cramping and it should be the first line of treatment for lipedema as it is an extremely low risk and relatively low cost and readily available treatment. Compression with or without other lymphatic stimulating treatment are an effective first line of therapy for managing lobules, wrist and ankle cuffs that occur with lipedema.
3. Why is Compression Garments Needed in All Stages?
Lipedema is characterized by painful and swollen fat which accumulates disproportionately in the subcutaneous tissue. New studies have shown that all stages of lipedema show increased swelling in the lower extremities as measured by Bioimpedance. In a study published this year in the Journal of Lymphatic Research and Biology, Crescenzi, Donahue, and Herbst showed that compared to controls all stages of lipedema have increased extracellular water or swelling. (R. Crescenzi, 2019) Further, the study showed that the edema or extracellular water increased with each stage of lipedema. We know that extremity edema or lymphedema is associated with multiple inflammatory processes that are responsible for pain, tenderness and progressive fibrosis of the affected areas. All the Standard of Care [Dutch (Damstra, 2017), German, and British (Coppel, 2017)] Guidelines for the management of lipedema recommend the use of compression for patients with lipedema [Stage 2,3]. All of the care guidelines recommend a multidisciplinary approach to treatment involving lymphedema therapists teaching patients manual lymphatic drainage, proper fitting compression garments, and instruction on the proper application of the compression garments. Therefore, we conclude that compression is usually needed in stage 1 lipedema and always needed in stage 2 and 3 lipedema.
4. Compression Physiology and How Compression Works in Lipedema
Compression Physiology and How Compression Works in Lipedema
When considering the use of compression therapy in the management of lipedema, the basic principles should be understood. The law of Laplace is a mathematical formula that defines the relationship between pressure P, tension T, radius R, and garment layers N.
The law of Laplace
P relative to N T/R
P = pressure
N = number of layers T = tension applied = radius of limb
5. What Pressure Are Considered Medical Grade and Recommended for Lipedema?
Medical grade compression strength varies by the affected limb and the severity of the edema or fluid accumulation. An arm requires less compression to aid lymph flow because it is both smaller than a thigh and closer to the heart so under less gravitational pressure difference. In general, 18 -20 mmHg [Mercury] is considered medical-grade compression for the arm and 30 – 40 mmHg strength at the ankle is considered a medical-grade compression strength for the leg. These recommendations are based on studies primarily of primary lymphedema as this is the strength required to cause a significant improvement in lymphatic flow. (Mosti, 2019) The studies of compression garments show those [e.g. 30-40 mmHg ankle and 18-20 mmHg wrist] pressures give both optimal venous blood flow and lymphatic fluid clearance from the affected limbs.
Sometimes compromises are made, and lower 20-30 mmHg compression is used for individuals who have very mild edema or who are just starting to use compression garments or because of extreme sensitivity to the pressure of the compression. Ideally, the lower 20 -30 graduated compressions are used as a stepping-stone until the heavier compression can be tolerated because the evidence for this lower strength of graduated compression controlling interstitial fluid is much weaker and not as trustworthy.
While it is yet to be proven that proper compression can reduce the progression of the lipedema at this time, the recommended graduated 30-40mmHg pressures at the ankle have been shown to be effective at minimizing edema, reducing symptoms and halting the progression of the disease in closely related lipedema, veno-lymphedema, and other diseases that are known to cause secondary lymphedema and therefore 30-40 mmHg strength at the ankle must be the goal of compression therapy.
(Source: lipedema.net)
中文解譯:********
為什麼要使用壓力服裝？脂膜水腫的壓力療法的目標是什麼？
1. 為什麼需要壓力衣服?
有很多理由考慮使用壓縮衣服。所有淋巴疾病的潛在問題是使淋巴循環回到靜脈系統的問題。對於患有脂性水腫，淋巴水腫或脂質淋巴水腫的個體，通常使用加壓衣來增加組織中的壓力，從而推動淋巴液通過身體，從而幫助淋巴循環。淋巴水腫會導致多餘的液體滯留在四肢，特別是腿上，壓縮衣對皮膚和靜脈施加壓力，幫助他們清除淋巴和充血。
除了改善淋巴流動外，還有一些關於壓縮服與脂肪疾病（如脂肪腫）有關的益處的爭論。多數患有脂肪水腫的人會因腫脹以及諸如站立或使腿或手依賴而促進局部腫脹的活動而使疼痛觸痛惡化。壓縮衣可以通過減少脂肪和整個肢體的腫脹來幫助減輕因脂肪紊亂脂肪水腫）引起的肢體疼痛和沈重感。同樣，壓縮可能會降低脂肪細胞的生長速度，並有助於防止脂肪疾病發展到更嚴重的漿液階段。換句話說，壓迫可以是針對脂性淋巴水腫或淋巴疾病引起的脂肪的最佳治療方法之一。
2. 脂質水腫的加壓療法的目標是什麼？
壓迫治療水腫的目標是：
已經顯示出壓縮可以減少不適，疼痛和四肢沉重以及支持組織的健康。
壓縮有助於簡化不均勻或扭曲的肢體形狀，並改善運動。
壓縮有助於減少組織間液的形成，從而減輕水腫，並促進靜脈和淋巴液回流到脂肪組織。 （Hardy，2016年）
所有這三個目標對於脂膜水腫的治療都是至關重要的。壓迫是所有其他治療水腫的基礎，因為壓迫是唯一能使每位水腫患者受益的治療方法。研究表明，醫學等級的分級壓迫是減輕肢體沉重，壓痛和腿抽筋的最普遍應用的有效治療方法，並且它應該是脂溢性水腫的第一線治療方法，因為它具有極低的風險，相對較低的成本並且易於獲得。伴有或不伴有其他淋巴刺激療法的壓迫療法是處理因脂肪性水腫而出現的小葉，腕部和腳腕袖口的有效療法。
3. 為什麼在所有階段都需要壓縮衣服?
脂肪水腫的特徵是疼痛和腫脹的脂肪過多地積聚在皮下組織中。新的研究表明，通過生物阻抗測量，脂溢水的所有階段均顯示下肢腫脹增加。在今年發表在《淋巴研究與生物學雜誌》上的一項研究中，Crescenzi，Donahue和Herbst表明，與對照組相比，所有形式的脂肪腫都增加了細胞外水分或腫脹。 （R.Crescenzi，2019）此外，該研究表明，水腫或細胞外水隨脂肪水腫的各個階段而增加。我們知道，肢體水腫或淋巴水腫與多種炎症過程有關，這些炎症過程導致受影響區域的疼痛，壓痛和進行性纖維化。所有的護理標準[荷蘭語（Damstra，2017），德國語和英國語（Coppel，2017）]脂膜水腫的治療指南均建議對脂膜水腫患者採用加壓治療[階段2,3]。所有護理指南均建議採用多學科的治療方法，其中涉及淋巴水腫治療師，教給患者手動淋巴引流，正確地穿著加壓衣以及正確使用加壓衣的說明。因此，我們得出結論，通常在1期脂肪水腫中需要壓縮，而在2期和3期脂肪水腫中總是需要壓縮。
4. 壓迫生理學和壓迫如何在脂肪水腫中起作用?
在考慮使用壓迫療法治療脂肪性水腫時，應了解基本原理。 拉普拉斯定律是定義壓力P，張力T，半徑R和衣服層N之間關係的數學公式。
拉普拉斯定律
P相對於N T / R
P =壓力
N =層數T =施加的張力=肢體半徑
5.什麼是壓力被認為是醫學等級的脂肪水腫？
醫學級抗壓強度因患肢和浮腫或積液的嚴重程度而異。手臂需要較少的壓縮以幫助淋巴流動，因為它既小於大腿又靠近心臟，因此在重力壓力差較小的情況下。通常，手臂的醫療壓力為18 -20 mmHg [水銀]，腳踝的醫療壓力為30 – 40 mmHg。這些建議主要基於原發性淋巴水腫的研究，因為這是引起淋巴水流明顯改善所需的強度。 （Mosti，2019）壓縮衣服的研究表明[ 30至40 mmHg的踝關節和18至20 mmHg的腕部壓力可提供最佳的靜脈血流和患肢的淋巴液清除率。
有時會做出妥協，對於患有輕度水腫的人或剛開始使用抗壓服的人或由於對抗壓壓力極為敏感的人，應採用較低的20-30 mmHg壓力。理想情況下，將較低的20 -30漸進壓縮用作墊腳石，直到可以承受較重的壓縮為止，因為控制間質液的漸進壓縮的這種較低強度的證據要弱得多，並且不那麼可信。
儘管尚不能證明此時適當的壓迫可以減少脂肪水腫的進展，但建議在腳踝處施加30-40mmHg的分級壓力可有效減輕水腫，減輕症狀並阻止疾病的進展緊密相關的脂肪水腫，靜脈淋巴水腫和其他已知會引起繼發性淋巴水腫的疾病，因此腳踝處30-40 mmHg的強度必須成為加壓療法的目標。
(資料來源Source: lipedema.net)