Treatment Report: G. D.
Diagnosis: Flebolinfedema AAII
Therapist: Dr. Debora Pentassuglia

Phlebo-lymphedema AAII in a patient with ischemic encephalopathy and consequent right hemiparesis.

A series of Vodder’s “Originalmethode” Manual Lymphatic Drainage massages was carried out for a total of 16 sessions spread over a month. The duration of each treatment was at least two hours.
There were four sessions of only Manual Lymphatic Drainage (MLD) and from the 5th session bandaging with zinc oxide and coumarin was also incorporated.
The patient needed the support of two people when walking. In the supine position the patient could perform a left knee flex of 20° to the maximum; the right leg does not perform active movements.
Upon taking responsibility, following a long cortisone therapy, the patient presented with blistering and ulceration of the skin in the left lower limb, with copious leaking of colourless and odourless liquid (photo 2). The patient reported to changing the dressing 3-4 times a day.
The lymphedema is distributed on both lower limbs with a positive fovea sign (photo 4).
The fibrotic consistency of the tissue requires the prolonging of the treatment time, but after the first 4 sessions good results are already apparent: measurements show an average reduction of 0.94 cm for the left limb and 0.9 cm for the right limb compared to the day on which treatment commenced.
On the 5th day the patient reported that he had not changed the dressings for two days because it had finally remained dry. At this point we proceeded with MLD on the lower limbs and bandaging with zinc oxide and coumarin on the left lower limb. Initially, the patient did not tolerate the bandage, so I suggested that he remove it if the discomfort were to augment. The next day the patient returned wearing the bandage.
There were daily improvements in the lower left limb, with healing of the skin ulceration and softening of the tissue.
On 21/12/2012 the measurements showed a further decrease in the average circumference of the limbs: left 2.02cm compared to the first day, and right 1 cm.
We proceeded with this treatment until 27/12/2012 when a decision is taken to also to bandage the lower right leg, because of two bubbles present at the ankle (photo 3).
Treatment proceeded until 11/01/2013 on agreement with the patient regarding the essential minimum number of sessions. On that date treatment discontinued with the patient under careful consideration.
Here are some photos from which you can evaluate the improvement of the state of the skin, as well as the reduction of lymphedema.

Fig.1: Left 10/12/1012 – Right 11/01/2013
Fig.2: Left 10/12/2012 – Right 14/12/2012
Fig.2a: Left 27/12/2012 – Right 11/01/2013
Fig.3: Left 27/12/2012 – Right 14/01/2013