Fifty patients undergoing major elbow procedures were randomized to negative pressure therapy using a device (n=25) or manual lymphatic drainage by a therapist (n=25). The primary outcome was limb circumference at five standardized landmarks. Secondary outcomes included pain (VAS) and inpatient length of stay; adverse events were tracked. Treatments began on postoperative day 1, lasted 20 minutes, and were applied once daily until discharge (analysis through day 6). Overall, the results of the study revealed that negative pressure achieved swelling reductions equivalent to manual lymphatic drainage, with a statistically greater hand-level reduction on day 3, and it produced lower pain scores on days 4 and 5. In short, negative pressure is an effective, easy-to-apply alternative or adjunct to manual lymphatic drainage for early postoperative decongestion after elbow surgery.