Effect of Ultrasound Cavitation Versus Pneumatic Compression on Adipose Tissue Thickness on Lipedema Patients

Lipedema is a progressive disease. There are currently 3 primary stages that describe disease severity: stage 1 involves thickening of subcutaneous tissue and disproportion accumulation of subcutaneous tissue in the extremities (tissue remains smooth and is generally not heavy or swollen); stage 2 is characterized by increased fibrous tissue, leading to a nodular feel in the subcutaneous tissue. Symptomatic lipedema patients at stage 2 and higher almost always have secondary swelling on physical exam and most with evidence of impaired lymphatic function. Stage 3 involves progression with the formation of lobules of skin and subcutaneous tissue Conservative therapies, including manual lymphatic drainage, compression therapy, decongestive sports/movement therapy, skin care, and empowerment are currently considered as first line treatments (2-4). Surgical reduction of pathological SAT with lymph-sparing liposuction in wet-technique is another potential therapeutic option to improve symptoms, mobility and overall quality of life The most promising techniques for noninvasive body sculpturing purposes are based on ultrasound-induced fat cavitation. Liporeductive ultrasound devices afford clinically relevant subcutaneous fat pad reduction without significant adverse reactions, noninvasive transcutaneous ultrasound cavitation is a promising and safe technology for localized reduction of fat and provides experimental evidence for its specific mechanism of action on the adipocytes. the most effective instruments for noninvasive fat reduction use ultrasounds through the generation of compression and depression cycles at appropriate frequency, they cause cavitation phenomena at the fat droplet-watery cytoplasm interface and eventually adipocyte rupture and triglyceride release. the thermal effects of focused ultrasound energy may result in adipocyte necrosis in the treatment area. The most recent devices for liporeductive purposes have been specifically designed to prevent unwanted tissue injury. a focused ultrasound emitter, was first demonstrated to achieve selective adipocyte lysis and clinically relevant reduction of the volume of subcutaneous fat pad, in the absence of significant adverse reactions.

Pneumatic compression devices move lymphatic fluid and support the elimination of proteinaceous fluids, thus leading to improved patient-reported symptoms, decreased limb girth and volume, increased elasticity of tissues, and fewer episodes of infection. Atan et al. found improvements in limb volume, pain, and physical functioning in patients with stage 3 or 4 lipedema after CDT or PCD treatmentSzolnoky reported daily treatment with CDT, PCD, and multilayered short-stretch bandaging performed for 5 days led to significant improvements in leg volume, capillary fragility, and pain in women with lipedema 90 patients will participate in the study for 3 months, and randomly be assigned into 3 equal groups. Study Group (A), (n =30) will receive fat cavitation 2 times /week for 3 months in addition to the complete decongestive therapy , study group (B), (n =30) will receive pneumatic compression 3-5 times /week in addition to the complete decongestive therapy, and control group (c), (n=30) will receive the complete decongestive therapy only.

Hypothesis:

This study will test the following hypothesis:

• There is no effect of cavitation on the adipose tissue thickness in patients with lipedema.
• There is no effect of pneumatic compression on adipose tissue thickness in patients with lipedema.

Basic assumption:

• It will be assumed that:

1. All patients will be free from any condition that may affect or delay the response to our program such as diabetes, open wound or hypertension.
2. The assessment methods will be valid and reliable.
3. All patient will be accurately diagnosed and exclude any other similar conditions as lymphedema, lipohypertrophy or Dercum's disease.
4. All patients will be cooperative during the assessment and treatment.