Discussion
postoperative swelling, MLD, swelling, inflammation, heterotopic-ossification, pain, trauma
ADVERSE EVENTS, INFLAMMATION, MLD, LYMPHEDEMA, PATHOLOGY
In this prospective randomized controlled trial, we compared the effect of a technical device based on negative pressure application to manual lymphatic drainage in the context of postoperative swelling after elbow surgery in 50 consecutive patients.The elbow joint is considered particularly important in every activity of daily living as it is contributing significantly to the positioning of the hand. Moreover, a normal elbow function itself is crucial for using the upper limb and therefore functional activities [Due to its anatomical complexity, the elbow joint is particularly prone to stiffness after trauma [Current rehabilitation treatment after elbow surgery is lacking standardized guidelines. Generally accepted is that principles in post-surgical rehabilitation should focus on early mobilization, whenever possible, control of pain and inflammation [The aim must be to optimize the therapy that reduces limb swelling, as it could improve and fasten patients´ recovery after surgery whilst reducing the occurrence of adverse events.In this study, MLD and a device-assisted negative pressure treatment were performed on 25 patients each. We demonstrated that NP is an effective treatment for the reduction of limb swelling after elbow surgery as it showed an adequate reduction of the affected limb´s circumference in a typical postoperative course. In comparison to the current gold standard, MLD, the results of NP therapy displayed a reduction in swelling which was just as effective as the gold standard with a slightly better reduction measured almost every day. However, a statistically significant difference was only found on day three at the level of the wrist (Saul et al. investigated the effect of negative pressure treatment on the upper extremity within a single-center prospective study in 45 patients. Consistent with our findings, they showed that negative pressure therapy could effectively reduce acute limb swelling after trauma and therefore decrease the time to surgery [Whenever possible, early joint mobilization is crucial in most elbow pathologies in post-surgical rehabilitation as prolonged immobilization is considered a significant risk factor for poor functional outcome and the occurrence of heterotopic-ossification (HTO) [Further, the perception of pain is substantially affecting musculoskeletal movement function. Therefore, adequate pain control in the rehabilitation of elbow pathologies is crucial.Previous findings show that decongestive measures after extremity surgery have an analgesic effect [This study is accompanied by some limitations. We must state, that while both methods showed an equivalent effect on postoperative swelling, we did not include a control group that did not receive any therapy for lymphedema. Nevertheless, we have minimized confounding variables by ensuring comparable patient demographics and ensuring that surgical- and postoperative treatment via NP and MLD were performed by the same surgical team or physiotherapist, respectively.Furthermore, indications for the performed elbow surgeries were very heterogeneous. Some patients suffered an acute trauma with corresponding swelling already present prior to surgery and some patients were implanted electively with an elbow prosthesis without significant preoperative swelling. This makes direct comparison difficult. In the future, an additional study of a single elbow pathology with its appropriate surgical therapy should be investigated.Nevertheless, the present study is a pilot study designed to investigate the feasibility and comparability of NP to MLD in the context of postoperative swelling after typical elbow procedures. Especially in elbow surgery, swelling of the joint poses a major challenge for surgical therapy and consecutive subsequent treatment. Therefore, our study can contribute to investigating rehabilitation protocols for their effectiveness and show that decongestive measures are an important component in reducing postoperative swelling.