A Randomized Controlled Trial Comparing Platelet-Rich Plasma, Low-Level Laser Therapy, and Complex Decongestive Physiotherapy in Patients with Lower Limb Lymphedema

Background: Platelet-rich plasma (PRP) is an autologous concentrated preparation of platelets characterized by lymphangiogenetic and tissue-repairing effects. Although PRP has been safely used in many different fields, there is no clinical study regarding the use of PRP in lymphedema treatment in humans. We assessed the clinical outcomes of PRP in patients with lower extremity lymphedema (LEL) in a randomized controlled trial. Methods and Results: Patients with secondary LEL were randomly allocated to one of three groups consisting of treatment with PRP with complex decongestive physiotherapy (PRP+CDP group), low-level laser therapy with CDP (LLLT+CDP group), and only CDP (CDP group). Assessment of Lymphedema Quality of-Life Questionnaire (LYMQOL) for health-related quality of life, lower-extremity-circumference (LEC) for edema, tissue dielectric constant (TDC) for extremity volume, 6-minute walking test (6MWT) for functional capacity, and numeric rating scale (NRS) scoring for extremity fullness were evaluated both before and after treatment. Forty-five patients (68.8% female) with mean age 40.84 +/- 15.81 years were included in the study. Significant differences in LYMQOL, LEC, NRS, and TDC values both before and after treatment were found in all groups; however, there were no statistically significant difference in values between the three groups. In the PRP+CDP group, LYMQOL values had a larger effect size than the other two groups. Significant differences in 6MWT values both before and after treatment were found in PRP+CDP and LLLT+CDP groups; however, there was no statistically significant difference in the CDP group. Conclusion: This is the first clinical study to evaluate the usage of PRP in patients with secondary LEL. PRP might be an additional treatment option of lymphedema management; however, more clinical trials in humans are needed to yield more evidence in the usage of PRP in patients with lymphedema.