Lymphovenous leg ulcers (or veno-lymphoedema leg ulcers) The geko® device – a new treatment paradigm

15 Jan Lymphovenous leg ulcers (or veno-lymphoedema leg ulcers) The geko® device – a new treatment paradigm

Although lymphoedema is not directly responsible for leg ulcer development, it can affect wound healing¹ due to reduced tissue oxygenation from oedema². ​ Skin damage in an oedematous limb may lead to ulceration, often exacerbated by infections. ​ Chronic oedema is often synonymous with lymphoedema, with the presence of lymph drainage failure. ​ Peripheral oedema is usually classified by systemic causes such as local obstruction, heart failure, infection, nephrotic syndrome, injury, or tumours.

Veno-lymphoedema leg ulcers (also known as lymphovenous ulcers) and venous ulcers present overlapping challenges in wound care ⁴. ​ Venous ulcers primarily result from venous insufficiency, characterized by venous stasis increased hydrostatic pressure and skin barrier breakdown⁵. ​ Differentiation between these ulcers is critical as management varies significantly, but both benefit from interventions enhancing lower limb blood flow and reducing oedema ^6,7,8. ​

Treatment Challenges

Conventional treatment such as compression therapy are often contraindicated and problematic for veno-lymphoedema leg ulcers due to risks of exacerbating ischemia in patients with coexisting peripheral arterial disease (PAD), discomfort and pain due to swelling, and potential breakdown of skin barriers in fragile or infected tissue¹.

Improper application or excessive compression can worsen lymphatic damage. As a result, alternative approaches currently focus on manual lymphatic drainage (MLD), and skin protection¹. This underscores the need for individualized, multidisciplinary management strategies for patients with veno-lymphoedema leg ulcers, advocating for caution in applying compression therapy and promoting further research into safe and effective alternative or adjunctive therapies.

The potential for Neuromuscular Electrostimulation (NMES) ​

Neuromuscular electrostimulation (NMES) has emerged as a promising adjunctive therapy to enhance blood flow and lymphatic function in the lower limbs⁹​. NMES involves the application of low-frequency electrical impulses to elicit lower limb muscle contraction via stimulation of a nerve, increasing venous and lymph system return and tissue perfusion⁹

This study supports that NMES can improve lymphatic function and tissue perfusion. ​

The geko® device

In this recently published multi-centre randomised self-controlled trial¹⁰, the geko device, a wearable neuromuscular , demonstrated significantly increased venous, arterial and microcirculatory blood flow, transporting oxygenated blood to the wound bed, facilitating a doubling in the rate of healing in venous leg ulcer patients versus compression alone. A novel muscle pump activator, the geko device is also clinically proven to mitigate the inflammatory environment critical to tissue repair through the reduction of oedema.

This case report highlights the geko device effectiveness in reducing lower leg blistering, along with accelerating healing, a reduction in fibrotic oedema and a return to more normal skin integrity and improved mobility and quality of life in veno-lymphoedema patients.

For individuals with veno-lymphoedema-related leg ulcers, the geko device represents a novel, non-invasive approach with the proven ability to reduce oedema and accelerate wound healing – and save¹² health system costs.

The geko device is now available on prescription and is on the NHS Supply Chain.

For more information on the geko device click here

To read the full blog click here

References:

1. Mortimer P, Browse N (2003) The relationship between the Iymphatics and chronic venous disease. In: Browse N, Burnand KG, Mortimer PS. Diseases of the Lymphatics. Arnold, London: 293-6
2. Casley-Smith J, Casley-Smith JR (1997) Modern Treatment for Lymphoedema. 5th edn. Terrace Printing, Adelaide, Australia.
3. Green T (2007) Leg ulcer management in patients with chronic oedema. Wound Essentials 2: 46–58.
4. Mortimer PS, Rockson SG (2014) New developments in clinical aspects of lymphatic disease. J Clin Invest 124(3): 915–21.
5. Olga Krizanova, Adela Penesova, Alica Hokynkova, Andrea Pokorna, Amir Samadian, Petr Babula. Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology-based treatment. First published: 19 October 2023 International Wound Journal. https://doi.org/10.1111/iwj.14405.
6. Wigg J (2016) Fluoroscopy guided manual lymphatic drainage from research to the classroom. International Lymphoedema Framework Conference/Australasian Lymphology Association Conference.
7. Moore Z, Dowsett C, Smith G, et al (2019)TIME CDST: an updated tool to address the current challenges in wound care. J Wound Care 28(3): 154–61.
8. Williams A (2009) Chronic oedema in patients with CVI and ulceration of the lower limb. Br J Community Nurs 14(10): S4–8.
9. Yang, Wei, Yang, Kai, Browne, Martin, Bostan, Luciana and Worsley, Peter (2019). Wearable electrical stimulation to improve lymphatic function.IEEE.Org. doi:10.1109/LSENS.2019.2893478.
10. Bull, RH, Clements, D, Collarte, AJ, Harding, KG. The impact of a new intervention for venous leg ulcers: A within-patient controlled trial. Int Wound J. 2023; 1- 9. doi:10.1111/iwj.14107.
11. Connie Harris, Carol Ann Rabley-Koch, Dorace Ramage and Renee Cattryse. Debilitating chronic veno-lymphoedema: using a muscle pump activator medical device to heal wounds and improve skin integrity: case report.
12. Tuson R, Metry A,Harding K. Cost-effectiveness analysis of the geko™ device (an NMES technology) in managing venous leg ulcers in UK healthcare settings. IntWound J. 2024;21(10):e70048. doi:10.1111/iwj.7004812 of 12 TUSON ET AL.