Professor Neil Piller, Lymphoedema Research Unit, Department of Surgery, School of Medicine, FUSA,
Dr Olivia Lockwood, Dr Mark McEwen, Rob Smith, SA Biomedical Engineering, Research and Teaching Team, FMC,
Kai Harrison, Flinders University, Biomedical Engineering Student
Background
To many lymphoedema – which is a swelling of the tissues due to a malformation or damage to the lymphatic system by surgery and or radiotherapy – appears like a lipoedema. Lipoedema is heritable and due to a genetic defect in the formation of the micro circulation. The disease mainly appears in woman arms and then in the legs with an estimated 11-15% of Australians suffering from the condition.
Apart from the cause there are other differences between lymphoedema and lipoedema such as its symmetrical nature, its development from puberty, a tendency to bruise easily and the painfulness of the limbs as the day progresses.
However despite these differences there are many misdiagnoses. As a consequence of this many women with lipoedema are sent down the wrong treatment pathway. This results in poor treatment outcomes, continuing progression of lipoedema and its great effect on the individuals’ quality of life, activities of daily living and social and societal activities.
Development of the Angiosterrometer
Many years ago there appeared a paper which showed a manual suction device being used on the limbs of a person with lipoedema, (Fig 2). It was quite basic but apparently relatively useful in helping with the diagnosis of lipoedema. However it was forgotten about until recently, when the SA Biomedical Engineering Research and Teaching team at Flinders Medical centre was talking with me about the difficulties in diagnosis of lymphoedema and lipoedemas.
Following this Dr Olivia Lockwood, Dr Mark McEwen and Mr Rob Smith got together with me to see what could be done to further development the instrument.
The development at first involved a basic replication of the original instrument called a Parrot device; which applies a gentle suction to the skin causing the fragile capillaries of a lipoedema suffer to burst. The degree of capillary bursting is anticipated to relate to the severity of lipoedema.
After preliminary testing the device manufactured by the team was capable of creating colour differences in the skin after suction was applied. In order to record and automate the detection of these colour changes a smartphone was integrated into the final system. Utilising the camera within the device an app was designed by Kai Harrison, to record video of the skin during suction and automatically detect colours and patterns generated on the skin surface.
The enclosure for the final device (Figure 3) was designed and 3D printed by the R&T team. Ethics approval has been recently granted. The clinical trial will enable us to tell how well the device can differentiate between normal tissues, lymphoedematous tissues and those of lipoedema. Most importantly the trial will also determine if the device can make an early diagnosis of lipoedema. This will allow implementation of pro-active advice, treatment and management programs for these women, resulting in a halting or slowing of the progression of lipoedema.
Conclusion and outcomes
A chance discussion, an interchange of ideas between us all, is what has lead to the creation of this device! So simple but it took a multi-disciplinary team to develop it. It won’t be long now until we can measure its benefits to those at risk of or already with lipoedema. The objectivity that this instrument may provide will certainly make a difference!