2nd symposium Presentation May 2015 by Rockberry Scientific Solutions

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

IVT on diabetic macroangiopathy Dr. rer. nat. Bernd Stratmann Herz- und Diabeteszentrum NRW UK RUB 32545 Bad Oeynhausen

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

THE MEDICAL PROBLEM PAD = peripheral arterial (obstructive) disease chronic atherosclerotic process „narrowing“ of peripheral arterial vasculature seit 1984 predominantly affecting lower limb

Risk factors : smoking, diabetes, hypertension, dyslipoproteinemia Prevalence ~10%, ~30% in patients ≥ 50 years critical limb ischemia (CLI) = most severe manifestation results in limb loss, multimorbidity, death

definition is typically clinical/observational as patients presenting with true ischemic rest pain, non-healing ischemic ulcers, or gangrene PAD = independent predictor of limb loss

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

THE MEDICAL PROBLEM â&#x20AC;&#x201C; PAD CLASSES

Stage acc. Fontaine I

Symptoms

IIa

Pain free walking distance > 200m

IIb

Pain free walking distance < 200m

III

Ischemic rest pain

Ulceration, gangrene

seit 1984

Asymptomatic

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

DIABETES MELLITUS + PAD - 4fold increase of manifestations 1984 stage -seit ealier - progress is more rapid Outcome after surgical revascularisation is worse, mainly due to delayed diagnosis 10-16fold increase to undergo major amputation 50% of patients die within 2 years after MA >85% of major amputations in patients with diabetes are preceded by foot ulceration (PAD and DNP (and mixed types) as equivalent causes)

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

getABI â&#x20AC;&#x201C; Situation in Germany

seit 1984

http://allgemeinmedizin-simsch.com

Diehm C et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004 Jan;172(1):95-105.

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

1 in 5 people over 65 â&#x20AC; has PAD

seit 1984

Only 1 in 10 of these patients has classical symptoms of intermittent claudication (IC)

â&#x20AC; ABI<0.9

Diehm C et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004 Jan;172(1):95-105.

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

Diehm C et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004 Jan;172(1):95-105.

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

Diehm C et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004 Jan;172(1):95-105.

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

THE SOLUTION = INCREASE FLOW!

seit 1984

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

CASES TO TREAT

89year old female patient (T2DM, DFS (W/A3D), PAD(IV), CAD, AF (pacemaker), Hypertension, Dyslipoproteinemia, renal insufficieny G3A1) seit 1984 represents a multimorbid, palliative setting, no vascular revascularisation/catheterisation possible TcPO2 before and after IVT 4-phase-programme (accelerating time and vacuum up to -30 mbar) 6 therapeutic sessions

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

BEFORE TcPO2 left: 12 bzw. 18 mmHg right: 9 bzw. 4 mmHg

AFTER TcPO2 left: 25 bzw. 45 mmHg right: 29 mmHg

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

CASES TO TREAT

72year old male patient (T1DM, DFS (W/A1C), PAD(IV), CAVK, AF, Retinopathy, DPN, Hypertension, Dyslipoproteinemia, renal insufficieny G3) seit 1984 represents a multimorbid, palliative setting, no vascular revascularisation/catheterisation possible TcPO2 before and after IVT 4-phase-programme (accelerating time and vacuum up to -30 mbar) 14 therapeutic sessions

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

BEFORE TcPO2 left: 25 bzw. 30 mmHg right: 15 bzw. 17 mmHg

AFTER TcPO2 left: 35 bzw. 40 mmHg right: 20 bzw. 25 mmHg

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

CASES TO TREAT

68year old male patient (T2DM, DFS (W/A1C), PAD(IV), CAVK, CAD, AF, Retinopathy, DPN, Hypertension, Dyslipoproteinemia, renal insufficieny G3) seit 1984 represents a multimorbid, palliative setting, no vascular revascularisation/catheterisation possible TcPO2 before and after IVT 4-phase-programme (accelerating time and vacuum up to -30 mbar) 5 therapeutic sessions

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

BEFORE TcPO2 left: 10, 50, 60 mmHg right: 33 mmHg

AFTER TcPO2 left: 50 bzw. 55 mmHg right: 35 mmHg

Directly after : successful aortic valve replacement

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

CASES TO TREAT

75year old male patient (T2DM, DFS (W/A3D, W/A4D), PAD(IV), CAD, AF, Retinopathy, DPN, Hypertension, Dyslipoproteinemia) seit 1984 represents a multimorbid, palliative setting, no vascular revascularisation/catheterisation possible TcPO2 before and after IVT 4-phase-programme (accelerating time and vacuum up to -30 mbar) 5 therapeutic sessions

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

seit 1984

BEFORE TcPO2 left: 35 mmHg right: 13, 27, 27 mmHg

AFTER TcPO2 left: 45 mmHg right: 20, 20, 30 mmHg

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015) The observational, randomized study Screening1

EOS2

Therapeutic phase(unblinded) 28 Patients -50 mbar 28 Patients -10 mbar

seit 1984

6 cycles

速 1 2 EOS

15(EOS)

Study day

R=Randomisation EOS= end of Study 1 Screening: ABI, TcPO 2 2 EOS: ABI, TcPO 2

Primary objective: qualitative improvement in perfusion Secondary objective: quantitative improvement ABI, TcPO2, QoL, relief of pain

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

Key inclusion criteria

seitcriteria 1984 Key exclusion

• • • •

• • • • • • •

T1DM, T2DM PAD II-IV TcPO2 ≤ 25 mmHg 18 to 80 years of age

=> Results to be awaited next year

Heart failure NYHAII-IV Dialysis on same day Phlebothrombosis PTA/PTCA/Bypass during therapy iliac artery occlusion Pregnancy …

2nd IVT-Symposium in Frankfurt, Germany (30.05.2015)

~ 60.000 amputations per year Strong demand for alternative concepts Blood flow provides periphery with oxygen and nutrients

Herz- und Diabeteszentrum NRW, Bad Oeynhausen | www.hdz-nrw.de

Lymphatic Microsurgery and Intermittent Suction Therapy (Vacumed) for Lymphedema

C. Campisi, F. Boccardo, C.C. Campisi Department of Surgery Section of Lymphology & Microsurgery Operative Unit of Lymphatic Surgery Operative Unit of Plastic & Reconstructive Surgery IRCCS University Hospital San Martino - IST National Institute for Cancer Research Genoa, Italy campisi@unige.it www.lymphaticsurgery.org

The Pioneer Tosatti’s Device…: Genova, 1967! NEGATIVE PRESSURE SUCTION THERAPY

HYPERBARIC OXYGEN THERAPY

Designed for NASA...

Lower Body Negative Pressure Device (LBNPD) â&#x20AC;˘Developed for manned space missions in the 1960s â&#x20AC;˘Designed to ensure the perfusion of lower limbs in orbit Fortney, S.M. Development of lower body negative pressure as a countermeasure for orthostatic intolerance. J Clin Pharmacol 1991; 31:888-92.

Developed for health professionals...

AOD cases

Straminski et al. Result of clinical examination., Praxis Kรถln., 2001

Arthroscopic meniscus repairs

Orlietzky, A. Đ&#x161;., Timtchenko, D. O. Use of devices for intermittent negative pressure therapy for treatment of athletes., Moscow, 2009

Intermittent pressure

â&#x20AC;˘ Fluctuates between phases of negative and positive (normal) pressure

Negative Pressure • Triggers the movement of circulating blood volume into lower extremities and abdomen • Reduction of blood pressure in the central vein and heartbeat volume • Compensatory mechanisms: increase in pulse rate and peripheral vessel resistance, activation of sympathetic response such as catecholamine secretion • Increase in amount of oxygenized and deoxygenized haemoglobin in muscles of lower extremities Gasiorowska et al. Cardiovascular and neurohormonal responses to lower body negative pressure (LBNP): effect of training and 3 day bed rest. J Physiol Pharmacol 2006; 57:85-100 Hisdal et al. Onset of mild lower body negative pressure induces transient change in mean arterial pressure in humans. Eur J Appl Physiol., 2002; 87:251–256.

Positive Pressure • Return to normal heart beat volume • Venous blood and lymph move into larger vessels (increased backflow) • Accelerated micro-perfusion and lymphatic drainage • pH increase strengthen connective tissue by increasing collagen synthesis

Lathers et al. Use of lower body negative pressure to assess changes in heart rate response to orthostatic-like stress during 17 weeks of bed rest. J Clin Pharmacol. 1994; 34:563-70. Goswami et al. LBNP: past protocols and technical considerations for experimental design. Aviat Space Environ Med. 2008; 79:459-71.

For Lymphatic Disorders? Reduction of oedema Increased microperfusion in lower extremities •Arterial and venous properties altered in lymphedemous limbs: • Lower venous tone • Slower venous return • Increased arterial blood flow into lymphedemous limb

Increased collagen synthesis & strengthened connective tissue •Reduction of cellulite in obesity with intermittent pressure therapy • Due to improved lymph flow and skin tone • Useful for Lymphedema and Lipoedema patients Montgomery et al. Segmental bloodflow and hemodynamic state of lymphedematous and nonlymphedematous arms. Lymphat Res Biol 2011; 9:31-42 Loberbauer-Purer et al. Can alternating lower body negative and positive pressure during exercise alter regional body fat distribution or skin appearance? Eur J Appl Physiol 2012; 112:1861-1871

For Lymphatic Disorders?

YES As part of a complete therapy regimen (CLyFT) In combination with Lymphatic Microsurgery

Staging of Lymphedema (ISL - SIL - ICF)

Clinical â&#x20AC;&#x201C; Lymphoscintigraphic Criteria

Immunohistochemical Criteria

Disability Grading

Staging of Lymphedema A. "Latent” STAGE I B. “Initial”

A. “Increasing” STAGE II B. “Column-shaped”

A. “Elephantiasis” STAGE III B. “Extreme Elephantiasis”

Lymphedema, without clinical evidence of edema, but with

impaired lymph transport capacity (provable by lymphoscintigraphy) and with initial immuno-histochemical alterations of lymph nodes, lymph vessels and extracellular matrix. Lymphedema, totally or partially decreasing by rest and draining position, with worsening impairment of lymph transport capacity and immuno-histochemical alterations of lymph collectors, nodes and extracellular matrix.

Staging of Lymphedema A. "Latent” STAGE I B. “Initial”

Lymphedema, with vanishing lymph transport capacity, relapsing A. “Increasing” STAGE II

lymphangitic attacks, fibroindurative skin changes and developing disability.

Limb Fibrolymphedema, characterized by lymphostatic skin B. “Column-shaped”

A. “Elephantiasis” STAGE III B. “Extreme Elephantiasis”

changes, suppressed lymph transport capacity and worsening disability

Staging of Lymphedema A. "Latent” STAGE I B. “Initial”

A. “Increasing” STAGE II B. “Column-shaped”

Properly called “Elephantiasis”, with scleroindurative pachydermitis, A. “Elephantiasis” STAGE III B. “Extreme Elephantiasis”

papillomatous lymphostatic verrucosis, no lymph transport capacity and life-threatening disability

With total disability

Staging of Lymph Vessel Impairment Stage III

Stage II

Stage I

Staging of Lymph Nodal Impairment Stage III

Stage II

Stage I

An Unexpected Role…

Interstitial Matrixâ&#x20AC;Ś

A frequent question… Not a predictable answer…

CPT alone? When? Micro alone? When? CPT + Micro? When?

CLyFT with VACUMED Therapy for LYMPHEDEMA

CPT 6-12 Months

Microsurgery 1 week

Post-op Rehab FU (3-5 years)

Microsurgical Treatment of Lymphedema Kinds of Lymphedemas suitable for treatment with Microsurgery:

– – – – – –

Primary “obstructive” arm and leg lymphedemas Secondary arm and leg lymphedemas Unilateral lymphedemas Bilateral lymphedemas Ideal indication: IB - IIA stage lymphedemas Good results also for IIB - III stage lymphedemas

Lymphatic Microsurgery

LVA

LVLA

Lymphatic – Venous Anastomoses

Lymphatic – Venous –

Lymphatic Anastomoses

Multiple LVA

External Venous Valve Plasty

1973-2011 2487 Cases Treated by Microsurgery LVA / LVLA (FU 5-15 Years)

CLyFT with VACUMED Therapy for LYMPHEDEMA

P < 0.01

Stages of Lymphedema Treated by Microsurgery (1973-2011)

Reconstructive LVLA

Reconstructive LVLA Preop. Postop. After >20 years

Lymphatic Microsurgery Antibiotics (preoperative short-term therapy Post-operative Treatments

and, after, long-acting penicillin for 1-2 years). LMWH, for the first 3 days post-op and then, aspirin 100-150 mg. for 6-12 months. Functional multilayer bandages are applied for the first week and, afterwards, proper elastic supports (stockings, sleeves, etc.) for at least 3-5 years, allowing the patient to progressively give up the use of these compression garments after the first 1-3 years, depending on lymphedema stage

Lymphatic Microsurgery Mechanical intensive lymphatic drainage Adjuvant Treatments

for the two weeks preceding the week of hospitalization for the surgical operation. Post-operatively: manual lymph drainage for the first 3-5 days and, then, low mechanical lymph drainage for another week. The follow-up consists of periodic clinical assessments (volumetry, measurements of circumferences, etc.) and instrumental evaluations (by lymphoscintigraphy).

Some of our clinical casuistryâ&#x20AC;Ś Preop. Postop.

Postop.

Preop. Postop.

Preop.

Postop.

Preop. Postop.

Preop.

Postop.

Preop.

Postop.

Preop. Preop.

Postop. Postop.

Preop. Preop.

Postop. Postop.

CLyFT with VACUMED Therapy for LYMPHEDEMA

P < 0.01

Lymphatic Microsurgery combined with Intermittent Suction Therapy (Vacumed) have highly significant results for an effective and long-term treatment of Peripheral Lymphedema

Surgery and Translational Lymphology

Infections

Traumas

Chyliferous vessels

Prevention

Tumors

Cisterna chyli Thoracic duct

Primary and Secondary Prevention of Lymphatic Lesions Plastic and Reconstructive Surgery

Urological Surgery

General Surgery

Gynecological Surgery Vascular Surgery

Latest Main References 1.

Dellachà A, Boccardo F, Zilli A, Napoli F, Fulcheri E, Campisi C. Unexpected Histopathological Findings in Peripheral Lymphedema. Lymphology 2000;33(Suppl):62-64.

Bellini C, Boccardo F, Campisi C, Villa G, Taddei G, Traggiai C, Bonioli E. Lymphatic dysplasias in newborns and children: the role of lymphoscintigraphy. J Pediatr. 2008 Apr;152(4):587-9.

Boccardo F, Bellini C, Eretta C, Pertile D, Da Rin E, Benatti E, Campisi M, Talamo G, Macciò A, Campisi C, Bonioli E, Campisi C. The lymphatics in the pathophysiology of thoracic and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery. Microsurgery 2007;27(4):339-45.

Campisi C, Bellini C,Eretta C, Zilli A, Da Rin E, Davini, Bonioli E, Boccardo F. Diagnosis and management of primary chylous ascites. J Vasc Surg. 2006 Jun;43(6):1244-8.

Campisi C, Da Rin E, Bellini C, Bonioli E, Boccardo F. Pediatric lymphedema and correlated syndromes: role of microsurgery. Microsurgery 2008;28(2):138-42.

Campisi C, Boccardo F. Vein graft interposition in treating peripheral lymphoedemas. Handchir Mikrochir Plast Chir. 2003 Jul;35(4):221-4.

Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg. 2004 Jun;28(6):609-13.

Campisi C, Eretta C, Pertile D, Da Rin E, Campisi C, Macciò A, Campisi M, Accogli S, Bellini C, Bonioli E, Boccardo F. Microsurgery for treatment of peripheral lymphedema: long-term outcome and future perspectives. Microsurgery 2007;27(4):333-8;

Latest Main References 10. Pardini M, Bonzano L, Roccatagliata L, Boccardo F., Mancardi G, Campisi C. Functional magnetic resonance

evidence of cortical alterations in a case of reversible congenital lymphedema of the lower limb: a pilot study. Lymphology 2007 Mar;40(1):19-25.

11. Gloviczki P. Handbook of Venous Disorders. Third Edition. Guidelines of the American Venous Forum. Edward Arnold Publ. 2009;658-672.

12. Boccardo F, Casabona F, De Cian F, Friedman D, Villa G, Bogliolo S, Ferrero S, Murelli F, Campisi C. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol 2009.

13. Boccardo F, Bellini C, Girino M, Campisi C, Vidali F, Corazza GR, Campisi C. Diagnostic assessment and therapeutic approach for immunodeficiency due to chylous dysplasia: a case report. Microsurgery 2010 Jul;30(5):401-4.

14. Boccardo F, Campisi C, Murdaca G, Benatti E, Boccardo C, Puppo F, Campisi C. Prevention of lymphatic injuries in surgery. Microsurgery 2010 May;30(4):261-5.

15. Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 2010 May;30(4):256-60.

16. Suami H, Chang DW. Overview of surgical treatments for breast cancer-related lymphedema. Plastic and Reconstructive Surgery Journal 2010 Dec;126(6):1853-63.

17. Boccardo F, Casabona F, Friedman D, Puglisi M, De Cian F, Ansaldi F, Campisi C. Surgical prevention of arm lymphedema after breast cancer treatment. Ann Surg Oncol 2011.

18. Witte MH, Dellinger MT, McDonald DM, Nathanson SD, Boccardo FM, Campisi CC, Sleeman JP, Gershenwald JE. Lymphangiogenesis and hemangiogenesis: potential targets for therapy. J Surg Oncol. 2011 May;103(6):489-500.

19. Campisi C, Witte MH, Fulcheri E, Campisi C, Bellini C, Villa G, Campisi C, Santi PL, Parodi A, Murdaca G, Puppo F, Boccardo F. General Surgery, translational lymphology and lymphatic surgery. International Angiology 2011;30(6):504521.

Latest Main References 20.

Campisi C, Campisi C, Boccardo F. Topics in cancer survivorship. Chapter 4 (pp. 43-52), Surgical prevention of arm lymphedema in breast cancer treatment. InTech Publisher, January 2012.

21.

Campisi CC, Spinaci S, Lavagno R, Larcher L, Boccardo F, Santi PL, Campisi C. Immunodeficiency due to chylous dysplasia: diagnostic and therapeutic considerations. Lymphology 2012 Jun; 45(2):58-62.

22.

Boccardo F, Campisi CC, Molinari L, Dessalvi S, Santi PL, Campisi C. Lymphatic complications in surgery: possibility of prevention and therapeutic options. Updates Surg. 2012 Sep.;64(3):211-6. Epub 2012 Jul. 21.

23.

Campisi CC, Larcher L, Lavagno R, Spinaci S, Adami M, Boccardo F, Santi PL, Campisi C. Microsurgical primary prevention of lymphatic injuries following breast cancer treatment. Plast Reconstr Surg 2012 Nov;130(5):749e-750e.

24.

Boccardo F, Fulcheri E, Villa G, Molinari L, Campisi C, Dessalvi S, Murdaca G, Campisi C, Santi PL, Parodi A, Puppo F, Campisi C. Lymphatic microsurgery to treat lymphedema: techniques and indications for better results. Ann Plast Surg 2012 (in press).

25.

Fulcheri E, Pacella E, Ceriolo P, Campisi C, Boccardo F, Campisi C. A new classification to define primary dysplastic lymphedemas. Lymphology 2012 (in press).

‘Le Giornate Genovesi della Chirurgia Italiana’ GENOA, ITALY

24th June 2013 – Opening 25-26-27 June 2013 – Joint Congress

THE USE OF IVT IN A WOUND CARE PRACTICE

Liezl Naude Wound Management Specialist BCur, MCur, Cert Wound Care (UFS), Cert Wound Care (Hertfordshire), IIWCC (SUN/Toronto)

L NAUDE WEYERGANS GERMANY 2015

WOUND MANAGEMENT INNOVATION Established 2000 Holistic patient centred approach Multidisciplinary team Focussed on lower limb management

Specialised diagnostic tests and screening methods IVT

L NAUDE WEYERGANS GERMANY 2015

ELOQUENT LEARNING HEALTH Established 2005 Practical hands on training Evidence based practice Multidisciplinary team

Short courses Symposiums Conferencing

L NAUDE WEYERGANS GERMANY 2015

ELOQUENT WELLNESS

Early diagnostics

Optimising wellbeing and healing

Rehabilitation

L NAUDE WEYERGANS GERMANY 2015

PATIENT PROFILE

Diabetes

Venous leg ulcers

Arterial insufficiency

Post op surgery

Lymphoedema

L NAUDE WEYERGANS GERMANY 2015

BASELINE TREATMENT PROTOCOL If improvement not as expected re-assess the patient

Evaluate weekly: Leg circumference Wound size Wound bed Pain Saturation levels

IVT and Wound management

Epidemiology involved i.e. Diabetes, Cardiovascular disease

Medical history Current problem Patient Centred concerns

IF ABPI LESS THAN 0.6 PATIENT IS FIRST REFERRED TO VASCULAR SURGEON BEFORE COMMENCING TREATMENT Program according to individual needs of the patient

Vascular status Leg Measurement Saturation rate

Wound Assessment Pain assessment

ABPI & palpable pulses Capillary refill Ankle, calf and thigh measurement Saturation %

Photograph with ruler Longest width x longest length Pain scale 0-10

L NAUDE WEYERGANS GERMANY 2015

CASE EXAMPLES L NAUDE WEYERGANS GERMANY 2015

PATIENT WITH CHRONIC VENOUS HYPERTENSION WITH LYMPHATIC COMPONENT FOR 6 YEARS. Session 1 R leg Thigh = 48, calf =39,5cm, Ankle = 28,5cm

Leg Thigh =47, calf 48cm, ankle = 30.5cm

Oxygen saturation % 88% - 92%

Session 5 R leg Thigh = 45, calf =34,5cm, Ankle = 24cm

Leg Thigh =45, calf 36.5cm, ankle = 26.5cm

Oxygen saturation % 90% - 94%

L NAUDE WEYERGANS GERMANY 2015

PATIENT WITH 7 YEAR HISTORY OF CHRONIC LYMPHOEDEMA AND ECZEMA Session 1

SESSION 1

SESSION 12

L NAUDE WEYERGANS GERMANY 2015

PATIENT WITH CHRONIC ULCERATION AND OEDEMA 3 YEAR ULCER HISTORY Session 1 R leg, calf =46cm, Ankle = 23cm

Leg, calf 48cm, ankle = 25cm

Oxygen saturation % 86% - 90%

Session 12 R leg, calf =41cm, Ankle = 21cm

Oxygen saturation % 92% - 96%

Leg calf 42cm, ankle = 21.5cm

L NAUDE WEYERGANS GERMANY 2015

DIABETES WITH LYMPHOEDEMA & MYCOSIS FUNGOIDIS 4 SEPTEMBER 2014

L NAUDE WEYERGANS GERMANY 2015

DIABETES WITH LYMPHOEDEMA & MYCOSIS FUNGOIDIS DATE 17 SEPTEMBER 2014

DATE 17 OCTOBER 2014

DATE 17 NOVEMBER 2014

L NAUDE WEYERGANS GERMANY 2015

TREATMENT PROTOCOL TREATMENT: 1. IVT which consists of 30minute sessions with exposure to negative pressure at -38mmHg - -50mmHg. 2. 3 times per week 3. LED light therapy with biofilm remover gel for 15 minutes 4. Wound dressing

CHALLENGES: Travel distance Infection Mycosis fungoides Radiotherapy

5. Modified compression bandaging L NAUDE WEYERGANS GERMANY 2015

ARTERIAL INSUFFICIENCY WITH LYMPHOEDEMA 25 JULY 2014

L NAUDE WEYERGANS GERMANY 2015

ARTERIAL INSUFFICIENCY WITH LYMPHOEDEMA DATE 11 AUGUST 2014

DATE 29 SEPTEMBER 2014

DATE 22 DECEMBER 2014

L NAUDE WEYERGANS GERMANY 2015

CHALLENGES: Travel distance Infection Lymphoedema Age Mobility

TREATMENT PROTOCOL TREATMENT:

1. IVT which consists of 30minute sessions with exposure to negative pressure at -38mmHg - -50mmHg. 2. 3 times per week

3. LED light therapy with biofilm remover gel for 15 minutes AFTER 10 DAYS AND 4 IVT SESSIONS

4. Wound dressing

L NAUDE WEYERGANS GERMANY 2015

WOUNDHEALING Improved circulation

<2 months

Improved tissue regeneration in proliferation phase

IVT

Cleaning up the dirt

SUCKING FRESH BLOOD INTO THE LEGS, SQUEEZING VENOUS BLOOD & LYMPH OUT, PURIFYING THE TISSUE FROM THE INSIDE

Kick starting the normal inflammatory phase

L NAUDE WEYERGANS GERMANY 2015

CONCLUSION

space with nothing in it

cleaning up the dirt providing a clear pathway for healing L NAUDE WEYERGANS GERMANY 2015

liezl@eloquent.co.za www.eloquent.co.za

L NAUDE WEYERGANS GERMANY 2015