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

Maximilian Weber; Jürgen Rahn; Michael Hackl; Tim Leschinger; Klaus Dresing; Lars P Müller; Kilian Wegmann; Andreas Harbrecht

doi:10.1007/s00402-023-04954-3

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

Arch Orthop Trauma Surg. 2023 Oct;143(10):6243-6249. doi: 10.1007/s00402-023-04954-3. Epub 2023 Jul 8.

Authors

Maximilian Weber¹, Jürgen Rahn², Michael Hackl², Tim Leschinger², Klaus Dresing³, Lars P Müller², Kilian Wegmann², Andreas Harbrecht²

Affiliations

¹ Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. maximilian.weber1@uk-koeln.de.
² Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
³ Department of Trauma, Plastic and Reconstructive Surgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.

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.

Keywords: Circumference; Elbow surgery; Manual lymphatic drainage; Negative pressure; Outcome; Postoperative swelling; Rehabilitation.

Publication types

Randomized Controlled Trial

MeSH terms

Edema / etiology
Edema / therapy
Elbow
Humans
Lymphedema* / complications
Manual Lymphatic Drainage* / adverse effects
Pain
Prospective Studies
Treatment Outcome