The concept

The concept of manual venous-lymphatic stimulation by “separated finger digital pressure”, takes into account the anatomy of the venous-lymphatic systems but equally the important role of the skin during a therapeutic massage.With a surface area of approximately 2m², for an average weight of 3kg, the skin represents the most voluminous tissue of our organism. 

Symbolically and very schematically, we can represent the human body in the following way :

       

(1) container    (2) contents

The skin is the centre of many interactions that participate in one’s equilibrium and homeostasis.

 A body temperature of 37°C is necessary for human life. 

The skin, which lies at the interface of the inside and outside of the human body, therefore ensures the important roles of protection, thermoregulation and the maintenance of this biological constant. 

                                                                                

 

The skin at the level of the dermis presents a dense microcirculatory network including many sensory receptors, notably fibres that belong to the vegetative nervous system.Touching the skin is, at the same time touching all of the elements it is made up of. Diagram : The different forces that act on the human body. The atmospheric pressure and the earth’s pull/gravity.  During a circulatory massage, it is very difficult, if not impossible, to act specifically on the vessels (lymphatic or blood). Touching the skin of a living person puts pressure on all of the vessels of the microcirculation and at the same time activates all of the mechanoreceptors within the dermis. This brings about, without the possibility to control it, mechanical effects with physiological consequences. Numerous studies have been developed from the observation of lymphatic vessels on cadavers but, in a living person, the microcirculation functions. The method “separated finger digital pressure”, that takes into account this notion, is practiced according to a specific protocol. During the practical sessions, there will be subjects with venous-lymphatic insufficiencies participating, enabling clinicians to practice on real subjects and materialize the different therapeutic indications of the method.

• Positioning of fingers

                     

Different clinical phenomena observed during sessions of stimulation.

• Effects on the sensory receptors (goosebumps/cutaneous horripilation)      
     
                

                      The presence of horripilation observed on the side of the body stimulated

• The effects on a wound (leg ulcer with plasma exudates)

               

                                                   Fig. A - Before a session of stimulation 

 

                                          

                              Fig.B - After a session of cutaneous stimulation (40 minutes)      

• The effects on a wound (leg ulcer with plasma exudates) – other examples

Fig 1.1	Fig 1.2
Fig 1.3	Fig 1.4

                                                                                                                                      

             

                                                                             Fig 2.1

             

                                               Fig 2.2 (natural cleaning of the wound by the macrophages)

             

                                                                 Fig 2.3 (granulation phase)

             

                                              Fig 2.4 Healing complete (60 sessions) – 1 session a week

• Mixed ulcer   

                 

                                                                         Fig. 3.1

                 

                                      Fig 3.2 (same ulcer, after 112 sessions – 1 session a week)

Around the ulcer, scar tissue/tissue healing With regard to the healing of the venous leg ulcer, our different observations show that the healing takes place simultaneously in the wound and at its periphery. The healing is however, more significant in the upper part of the wound (Fig 2.4 and 3.2). This phenomenon is probably related to orthostatism, with the existence of different pressure values depending on the level of the wound. The pain appearing in this type of pathology is present during the treatment, and goes through the phases of exacerbation and then remission. For the treatment of the leg ulcer, there is a specific protocol “we do not touch the wound”. At the end of the session, the wound is cleaner and healthier. The sessions, produce blood extravasation that re-triggers inflammation of the wound and it’s accompanying physiological and chemical activities.The reactions will be different from one subject to another; these are related to the nature of the ulcer and the terrain. During the stimulation study period, the wounds were not treated by any other local medical treatment (such as antibiotics).

REFERENCES

[1] M Vayssairat, Maurel A Gouny P, N Baudot, JP Gaitz, Nussaume O. The volumetric: an accurate method of quantification in phlebology. J Mal Vasc 19. 1994, 108-110.

[2] Auvert J.F, Mr. Vayssairat The volumetric an examination indispensable lymphology. Rev. Med Interne 2002; 23: 388-90

[3] Chavoutier P.L, Bouchet J-Y, Richaud C. Reproducibility and reliability measures perimeter of a lower limb healthy. Ann. Physiotherapist. 2000; 27; No. 1 :3-7

[4] Lardry JM, Raupp JC, Dammas P: morphological study of the thigh - KINESITHERAPIE, workbooks No. 26-27, 67-73, February-March 2004

[5] Galland Christophe, Jean François Auvert, Antoine Flahault, and Vayssairat Michel. Saint Antoine Faculty (Paris), Paris University, Tenon Hospital, Paris, France. Why and how post-mastectomy should be quantified edema in patients with breast cancer. Breast Cancer Research and treatment 75: 87-89, 2002

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