Combined coumarin and omental transfer treatments for canine proximal obstructive lymphoedema.

In a canine model both coumarin treatment (believed to act by increased local proteolysis) and surgical transfer of a bridge of vascularized, lymphatic-rich omentum cause significant reduction of experimental lymphoedema. The present paper describes the effects of consecutive application of these two types of treatment. Ten dogs were divided into two equal groups: Group 1 Coumarin treatment, 6 months; no treatment, 6 months; omental transfer, 6 months; or Group 2 Omental transfer, 12 months (biopsied at 6 months); coumarin treatment, 6 months. Prior to treatment the excess limb circumferences were 2.66 and 3.01 cm in Groups 1 and 2 respectively. In Group 1, 6 months coumarin treatment alone reduced swelling by 0.78 cm and the final reduction in swelling at 18 months was 1.03 cm. In Group 2, reduction in swelling 6 months after omental transfer alone was 0.96 cm and the final reduction at 18 months was 2.05 cm. The findings indicate that in Group 1 there is an additive effect of the two types of treatment. However, in Group 2 it is not possible to be certain whether the improvement that occurred between 6 and 18 months also reflects an additive effect or a later consequence of the earlier omental transfer.