Iris presented in 1997 with lymphoedema tarda of the whole of the left leg, but with no truncal or foot involvement. The condition had developed suddenly at age 60 following an accidental kick. DVT had been ruled out and a lymphangiogram several years after onset confirmed the diagnosis of lymphoedema. Previous treatment had consisted of a thigh-length class 3 compression stocking supplied by the surgical appliance officer of her local hospital.
Clinical examination of Iris's leg showed skin changes, fibrosed tissues, skin folds, and a large limb-volume difference (91% in total: 150% in the distal section, and 57% in the proximal section). The distal segment was distorted, and the weight of the leg had caused postural changes and back pain. Iris described her leg as 'feeling full' but it was not painful.
Iris's main concerns regarding her condition were:
Body Image
Obtaining Comfortable Hosiery
Back And Joint Pain
Iris was given 14 treatments of DLT over a 3-week period. A volume reduction from 150% to 45% was achieved after 3 weeks' treatment. She was then fitted with class 3 hosiery, a thigh-length stocking with a waist attachment, and taught self-care. She was monitored every 3 months. Over the following 9 months the volume difference increased again to 76%. A second course of DLT over 2weeks reduced the limb to 54% difference. The distal segment was 76% greater and the proximal segment 40%, greater than the unaffected right leg. At the end of this course of treatment. Iris was fitted with a CircAid legging to be worn over her thigh-length stocking.
Over a 6-month period, the limb gradually' refilled again, the distal segment volume increasing from 76% to 140% greater than the right side. The proximal segment changed very little. A third session of DLT was undertaken, which reduced the affected limb volume to 55% greater than the unaffected limb. Iris's limb volume remained static for 10 months with a combination of class 3 hosiery plus a CircAid legging.
At the end of this 10-month period, and with Iris's consent, the CircAid legging was removed for 1 week to monitor volume changes. The distal segment increased from 61% to 74%. Iris missed the support of the rigid structure of the legging and was pleased to have it reapplied.
Iris's affected leg has lost 2000 ml in volume -- approximately 2 kg in weight -- since initial assessment by the author. As a result, Iris has improved mobility and has experienced relief from her back and joint pain.
It is not clear why Iris needed another course of DLT following use of the CircAid legging. She had a serious pneumonia during the time and was not wearing her hosiery continuously. It may be that compliance was not as good as with the other patients, and that having to have another course of DLT strengthened her resolve to take the time to apply the garment daily.
Iris now wears ordinary tights and a skirt over her CircAid legging. She finds the legging easy to put on; however, the Velcro damages both her tights and the compression garment worn underneath the legging.