DOI: http://dx.doi.org/10.18203/2349-2902.isj20193338

The cost effective role of Eschmarch tourniquet and psychosocial awareness of disease as a key factor in decompressive therapy of filarial lymphedema

Arun Y. Mane, Narendra G. Naik

Abstract


Background: The filiariasis is the most common cause of secondary lymphedema of the lower limb. Due to poor awareness of this disease in the people of the lower socioeconomic strata, the patient understands the importance of conservative modality of therapy very late. The cutaneous changes and its complications develop in patient due to unawareness about the nature of noncurable progressive disease. The self-negligence to their own limb also contributes to increase in the morbidity of the disease. The article discusses about cost effective role of Eschmarch tourniquet as a decompressive therapy. The disease causes socioeconomic impairments, stigmatization due to elephantiasis and job insecurity due to cosmetic and functional disability.

Methods: This was a retrospective study done in 28 cases of filarial lymphedema. All patients received limb elevation and decompressive therapy by Eschmarch tourniquet.

Results: Out of 28 cases, 14 cases in study group of filarial lymphedema with pitting edema (71.42%) and non-pitting edema feet with minimal cutaneous changes (28.57%) showed significant reduction in size of limb girth and satisfactory fluctuating limb girth during the follow up period in OPD respectively, by adequate limb elevation, elastic stockinet and decompressive therapy by Eschmarch tourniquet as compared to the remaining 14 patients of control who received only limb elevation. The better follow up results are noticed by proper guidance to the patient about the disease and its conservative modality of treatment.

Conclusions: It is a challenge for the treating consultant to create early awareness about the nature of the filarial disease and early guidance about the conservative treatment which helps to restrict the rapid growth of limb size in filiariatic lymphedema. The eschmarch tourniquet is one of the cost effective decompressive therapy.

 


Keywords


Lower limb filarial lymphedema, Decompressive therapy, Eschmarch tourniquet, Patient counselling

Full Text:

PDF

References


Bourquelot P, Levy BI. Narrow elastic disposable tourniquet (Hemaclear®) vs. traditional wide pneumatic tourniquet for creation or revision of hemodialysis angioaccesses. J Vasc Access. 2016;17(3):205-9.

Eidelman M, Katzman A, Bialik V. A novel elastic exsanguination tourniquet as an alternative to the pneumatic cuff in pediatric orthopedic limb surgery. J Pediatr Orthop B. 2006;15(5):379-84.

Akinyoola AL, Oginni LM, Orimolade EA, Ogundele OJ. Esmarch tourniquet in orthopaedic surgery. Trop Doct. 2007;37(3):139-41.

Zaleska M, Olszewski WL, Durlik M. The Effectiveness of Intermittent Pneumatic Compression in Long-Term Therapy of Lymphedema of Lower Limbs; Lymphat Res Biol. 2014;12(2):103–9.

Partono F. The spectrum of disease in lymphatic filariasis; Ciba Found Symp. 1987;127:15-31.

Panicker KN, Dhanda V, Community participation in the control of filariasis. World Health Forum. 1992;13(2-3):177-81.

Douglass J, Graves P, Gordon S. Self-Care for Management of Secondary Lymphedema: A Systematic Review; PLoS Negl Trop Dis. 2016;10(6):e0004740.

Shenoy RK1, Management of disability in lymphatic filariasis--an update, J Commun Dis. 2002;34(1):1-14.

King CL, Suamani J, Sanuku N, Cheng YC1, Satofan S, Mancuso B, et al. A Trial of a Triple-Drug Treatment for Lymphatic Filariasis. N Engl J Med. 2018;379(19):1801-10.

Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment.; Cochrane Database Syst Rev. 2015;21(5):CD003475.

Tzani I, Tsichlaki M, Zerva E, Papathanasiou G, Dimakakos E. Physiotherapeutic rehabilitation of lymphedema: state-of-the-art. Lymphology. 2018;51(1):1-12.

Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: a review. Eur J Obstet Gynecol Reprod Biol. 2010;149(1):3-9.