Plastic Surgery

Telephone Numbers
AMLA MEDIQUIP
28/31Old Rajinder Nagar,
New Delhi -110 060 INDIA
Voice Phone : +91-11-25852291, 25853090
Fax +91-11-25860163
Cell +91-9810126883
VOIP Number (For Video Conferencing and Telemedicine)+91-11-29603306

VIPEL is a system designed after extensive research on Elephantiasis of Indian patients. It is based on the principle that lymphoedema is accumulated fluid in the limb which occurs due to failure of the lymphatic transport mechanism.

The lymphatics are small fine tubes occurring all over the body. Exchange of Oxygen, Carbon Dioxide, food and waste products takes place between the blood and tissues at the capillary level. During this process some of this fluid (called lymph) gets left behind from the blood capillaries. The lymphatics serve to remove excess lymph.

Swelling in the limbs occur when the lymphatic drainage process is inadequate. In heart and kidney disease, more gets left behind as more lymph is formed. In filariasis the lymphatics themselves are diseased. In Venous oedema again, more lymph is formed. In cancer, the lymph nodes (which act as filters) are a cause of blockage due to disease, radiation therapy or surgical removal.

WHAT IS VIPEL
VIPEL is a Variable Intermittent Pneumatic External Limb compression system. It helps to pump the excess lymph back into the Blood circulatory system and hence helps in reducing oedema.

Its effect is temporary as the main cause of lymph accumulation is not treated but it does give long term relief if due care is taken to continue ancillary measures.
The long term relief is due to the fact that residual excess lymph makes the limb prone to infection (manifested frequently in Filariasis patients as Filarial fever). Attacks of infection cause further blockage of lymph channels and subsequent persistence as well increase in swelling.

The ancillary measures required are - Continuous use of compression stocking, Regular and thorough cleaning of the foot, Preventive Antibiotics (esp Long term Penicillin therapy) as well as at the first sign of infection, avoiding injury and walking barefoot, regular massage etc.

MECHANISM OF ACTION
Lymphatic fluid is pumped externally by the action of the two components of VIPEL namely
(a) The pump and
(b) The encasing which has different sizes and shapes to suit required needs.

THE PUMP (VIPEL PUMP) is the intermittent source of air pressure to the ENCASING which is wrapped around the affected or required limb. The air is pumped in and out to the encasing by the pump to cause compression to the limb. This pressure is varied by the three different knobs provided on the front panel

• TIMER ON - This regulates flow to the encasing. It can be set between 10-180 seconds. During this time (After the initial filling period) the encasing will press the limb for the time set. The pressure gauge needle will rise slowly to the peak pressure required and remain their till this timer function is completed and switched to off.
• TIMER OFF - This is also a variable time setting device to regulate between 10-180 seconds for switching OFF the air pressure supplied to the encasing. During this time the pressure gauge needle will drop slowly to zero indicating that pressure is now equal to atmosphere pressure and remain so till the set time is completed. The off timer starts working as soon as the on time is completed. The TIMER ON will again switch on once the TIMER OFF finishes its function and hence the entire cycle is repeated automatically continuously till the machine is switched off. An indicator lamp glows every time the Timer On is in function.
• PRESSURE CONTROL KNOB - This is used to control the pressure transmitted to the limb. When fully opened, the pressure to the encasing will reach up to 180 mm mercury (an automatic release valve does not allow pressure beyond this for patient's safety).

The limb is completely enclosed in an inflatable encasing which is then inflated by the VIPEL pump. The limb is thus compressed circumferentially. The mono-locular chamber pushes the fluid in all directions with only a little going upwards. A slow rhythmic cycle of gradual full pressure and zero pressure is then initiated.

Compressed tissue is known to increase internal heat generation - activating the infection fighting cells - namely the macrophages to breakdown tissue protein. Decreased tissue protein is known to help in tissue fluid (i.e. the oedema) reabsorption The hardened dermis and subcutaneous tissue of lymphoedematous patients absorbs the pressure distributing it in a centrifugal direction due to an arch effect Thus the maximum pressure is distributed in the site where maximum swelling occurs.

Frequently Asked Questions :

1. How long should I use VIPEL? VIPEL needs to be used as long as further reduction in swelling is occurring. Generally 3-4 hrs a day is recommended. It can be at any time - even during sleep or watching TV or reading. Measurements should be taken weekly and once reduction is static, usage can be discontinued and a garment given. The exact need can be assessed by your doctor. A flow chart is given with the brochure.

1. How often should I use VIPEL? After initial reduction as per above, use of VIPEL may be required if or as and when swelling recurs. Generally with proper care, every 6 months or more often especially if stocking is torn or infection occurs.

1. What are the risks? Use of VIPEL is contraindicated in cases where fluid accumulation is not due to a localised cause (Filariasis etc) but due to Heart, Liver or Renal disease. This cause has to be treated or the problem may be exacerbated. In case there is evidence that a local cause also exists e.g Venous Oedema in a Heart patient, adequate initial treatment of the heart condition is mandatory through diuretics etc.

1. What is the follow up therapy? Long term Penicillin therapy, Foot care, Regular massage, Customized stocking.

1. Can I use it without Medical advise? It can be used if the user has had adequate training in the use and recognizes the proper danger signals and discontinues treatment as well as get medical advise. These are

• Active Infection or cellulitis - In this the limb gets warm to feel, red and painful with increase in swelling. Fever may occur.
• Acute Venous thrombosis - Occurs in cases with cancer or venous oedema, Symptoms are swelling pain and local change in colour. Hard cords may be felt.
• If use is painful - Pain occurs due to decreased blood flow to the limb caused by excessive or continuous unrelenting pressure. This may be caused by a failed or wrongly set Off timer. Pain starts at 10 - 15 minutes of continuous On pressure (the normal setting is less than 180 secs On and 30 -45 seconds Off). Harmful gangrene may set in if such use is continued for over 2 hours. This is possible only in people with paralysis, under alcohol influence, drug addicts as well as persons under anaesthesia. Such people cannot use it without medical supervision . (The clinical model, has a FAILSAFE MECHANISM for these patients but that is recommended for use by doctors only)

1. What are the contraindications? As in item 5 above.

1. What is the ancillary therapy? Ancillary therapy is

• •Skin hygiene including care of cuts, ulcers and fungal infection.
• •Leg elevation and massage, use of temporary stocking and/or crepe bandage in between compression therapy sessions.
• •Several courses of DEC (Hetrazan etc.), if not taken previously.
• •Monthly injections of Benzathine Penicillin if the patient is getting recurrent attacks of fever.
• •Regular self massage

1. What are the possible Complications? The complications possibly are

• Possible exacerbation of infection
• Increase in swelling if a constriction ring is formed by an improperly fitting stocking or crepe bandage.
• In states of insensitive limbs (as a result of paralysis or in excessive alcohol drinkers), the pain of misuse may be absent and unrestricted use may cause gangrene of the limb

1. Will I ever be totally disease free? No the problem can only be mitigated with VIPEL, not eliminated.

1. If not what advantage do I get from it? One can be more confident to walk and face the world if one has less swelling. Attacks of fever are decreased which can make a person be off work for long. Even death is known to occur in such fever attacks.

1. What if the machine stops working? A full replacement guarantee is provided with each machine. We despatch the replacement machine at the first information of malfunction, although that generally occurs due to improper voltage or spikes. Use of voltage stabilizer is strongly recommended

1. Which machine or encasing is suitable for me THE MACHINE The BASIC MODEL is recommended for general users. Doctors working with Filaria or Cancer should use the Clinical Model as it can serve two patient limbs at a time and has a failsafe mechanism. Special Filaria Clinics and Hospitals in endemic zones will find the 4 outlet Hospital Model means a quick fast patient turnover who can be managed through a single suitably trained para medical worker. Especial training for such workers can be arranged free of cost if sufficient orders are available.

THE ENCASING The encasing should generally go 5 - 10 cms above the position of the highest point of swelling. But it should never be longer than the limb length (for the leg - in the arm it does not matter). The brochure states the length of each encasing. The circumference (again stated in the brochure) should be 3- 10 cms than the maximum circumference of the limb. In case it is not so proper inserts are available - which help to increase the circumference. Generally the Short Leg Encasing suits most.

How do I order? Send a draft with full advance including relevant taxes (10% generally, 4% with C or D form) in the name of AMLA MEDIQUIP payable in New Delhi. The machine will be despatched within a week generally by the courier you recommend as the best one to serve your area. If you do not know which size of encasing is suitable, send the measurements of limb length, highest point of swelling and maximum circumference. A photograph of the limb will be helpful in deciding the proper encasing suitable for you.

Thanks!