Adjuncts: HBOT, laser and others

Evidence in one minute

• Hyperbaric oxygen: no benefit for chronic arm lymphoedema after breast radiotherapy (randomised phase II, 58 patients, 30 sessions at 2.4 ATA, no volume or functional difference at 12 months). Low certainty (revised 2026-10-08 from moderate after RoB 2: open label, 79% analysed). Uncontrolled studies report less breast oedema and pain; one case of breast oedema resolved (symptoms only, no oedema measure; JBI 5/8). Do not motivate HBOT for limb lymphoedema. Gothard 2010 · Meier 2023 · Carl 1998
• TcPO2 is normal in lymphoedematous arms — oedema alone does not create the hypoxia HBOT targets. Mayrovitz 2005
• Low-level laser: immediate softening and tissue-water fall at fibrotic sites, larger than sham (non-randomised); ISL: limited evidence, more for pain and tissue mobility than volume. Mayrovitz 2011
• Carboxytherapy: physiological rationale plus 15 uncontrolled patients treated with compression at the same time; the review states CO2 contains hydrogen. Does not support use (revised 2026-10-09). Varlaro 2007
• Negative pressure: incisional NPWT after node dissection (era-confounded, very low certainty); negative-pressure massage device vs MLD after knee replacement (manufacturer-funded). Full NPWT appraisals are in the NPWT Evidence Library. Poirier 2022 · Weber 2025