Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.

Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.

Jun 2012

Brorson H, Hansson E, Jense E, Freccero C.

Source

Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden. hakan.brorson@med.lu.se

Abstract

The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(®) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage.

Mary Ann Liebert

The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema.

Apr 2012

Moattari M, Jaafari B, Talei A, Piroozi S, Tahmasebi S, Zakeri Z.

Source

Department of Nursing, College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Keywords: Breast cancer, Lymphedema, Decongestive therapy, Pneumatic compression pump

BACKGROUND:

Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy (CDT) and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema (BCRL).

METHODS:

Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse in two phases. In first phase, CDT was accompanied by use of a compression pump for 4 weeks, 3 days per week. In second phase, CDT was performed daily without compression pump for 4 weeks by patients at home. At the end of each phase, the same primary measurements were done for patients.

RESULTS:

The mean volume difference of the upper limbs and mean difference in circumference in all areas at different phases decreased significantly. Mean flexion, extension, abduction and external rotation (in degrees) at different phases increased significantly.

CONCLUSION:

CDT significantly reduced mean volume and mean circumference of the affected limb, and significantly increased shoulder joint range of motion. The findings support the optimal effects of CDT in the treatment of secondarylymphedema of upper extremity. CLINICAL TRIAL REGISTRATION NUMBER: 138902212621N8.

NIH

A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema

A systematic review of the evidence for complete decongestive therapy in the treatment oflymphedema from 2004 to 2011.

August 2012

Lasinski BB, Thrift KM, Squire D, Austin MK, Smith KM, Wanchai A, Green JM, Stewart BR, Cormier JN, Armer JM.

Source

Lymphedema Therapy and The Boris-Lasinski School, Woodbury, NY.

Abstract

OBJECTIVE:

To critically analyze the contemporary published research that pertains to the individual components of complete decongestive therapy (CDT), as well as CDT as a bundled intervention in the treatment of lymphedema.

DATA SOURCES:

Publications were retrieved from 11 major medical indices for articles published from 2004-2010 by using search terms for lymphedema and management approaches. Literature archives of the authors and reference lists were examined through 2011.

STUDY SELECTION:

A research librarian assisted with initial literature searches by using search terms used in the Best Practice for the Management of Lymphoedema, plus expanded terms, for literature related to lymphedema. Authors sorted relevant literature for inclusion and exclusion; included articles were sorted into topical areas for data extraction and assessment of level of evidence by using a published grading system and consensus process. The authors reviewed 99 articles, of which 26 met inclusion criteria for individual studies and 1 case study did not meet strict inclusion criteria. In addition, 14 review articles and 2 consensus articles were reviewed.

DATA EXTRACTION:

Information on study design and/or objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted from each article. Study evidence was categorized according to the Oncology Nursing Society Putting Evidence into Practice level of evidence guidelines after achieving consensus among authors.

DATA SYNTHESIS:

Levels of evidence were only moderately strong, because there were few randomized controlled trials with control groups, well-controlled interventions, and precise measurements of volume, mobility and/or function, and quality of life. Treatment interventions were often bundled, which makes it difficult to determine the contribution of each individual component of treatment to the outcomes achieved.

CONCLUSIONS:

CDT is seen to be effective in reducing lymphedema. This review focuses on original research about CDT as a bundled intervention and 2 individual components, manual lymph drainage and compression bandages. Additional studies are needed to determine the value and efficacy of the other individual components of CDT.

Elsevier-Science Direct

Lymphoedema treatment in palliative care: a case study.

August 2012

Cooper G.

Abstract

This article will focus on the evidence to support the treatment of a palliative patient who was diagnosed with cancer-related secondary lymphoedema. A case study approach has been adopted, which focuses on the anatomy and physiology oflymphoedema and how this is treated through an analysis of the treatment regimens. To establish the effectiveness of thesetreatment regimes, the use of objective and subjective tools will also be analysed to ascertain their importance within care. The findings of this case study and the supporting evidence indicate a positive correlation between the use of lymphoedematreatment methods in both limb volume reduction and quality-of-life outcomes. However, robust evidence is required to expand the importance of each treatment used in the area of lymphoedema management.

Internurse.com

Pressure monitoring of multilayer inelastic bandaging and the effect of padding in breast cancer-related lymphedema patients.

Sept 2012

Kang Y, Jang DH, Jeon JY, Lee SJ, Jeong SY, Shin DI, Kim HJ.

Source

From the Department of Rehabilitation Medicine (YK, JYJ, SJL, SYJ), Department of Biomedical Engineering (DIS), and Department of Biostatistics (HJK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea (D-HJ).

Abstract

OBJECTIVE:

This study of pressure monitoring of multilayer inelastic bandaging and the effect of padding in breast cancer-related lymphedema patients aimed to measure the resting and working sub-bandage pressures in compression therapy forlymphedema patients and to determine whether applying additional padding has an additional effect in volume reduction of the limb.

DESIGN:

Forty-eight patients with breast cancer who were beginning complex decongestive therapy for lymphedema were included. In 24 patients, padding was added to the forearm. A short-stretch bandage with or without padding was applied to the affected arm. The working pressure was measured while the patients squeezed a rubber device. The forearm limb circumference was measured before and after 2 wks of treatment.

RESULTS:

The mean (SD) of the resting pressure was 36.3 (2.2) mm Hg without padding and 49.5 (3.2) mm Hg with padding. The mean (SD) of the working pressure was 9.5 (3.7) mm Hg without padding and 24.3 (9.1) mm Hg with padding (P < 0.05). The volume loss after treatment was significantly greater in the group with added padding (P < 0.05).

CONCLUSIONS:

The working pressure during exercising with a force of 50 Pa is approximately 10 mm Hg with a short-stretch bandage applied. Adding a pad increases both the resting and the working pressure and also seems to be effective in increasing volume reduction of the limb.

Lippincott, Williams & Wilkins

Practical Solutions for Lymphaticovenous Anastomosis.

Aug 2012

Lasso JM, Cano RP.

Source

Department of Plastic Surgery, Hospital Gregorio Marañon, Madrid, Spain.

Abstract

Lymphedema is a chronic debilitating disease affecting a considerable part of the population that results from impairment of the lymphatic system. Lymphovenous anastomosis (LVA), a technique that attempts to achieve a physiologic lymphatic load of the edematous limb, is an accepted treatment. Techniques make anastomosis of 0.3 to 0.8 mm lymphatics to subdermal veins possible, but it is a challenge for microsurgeons because it requires a high degree of concentration and skill. An associated problem that we sometimes face when doing LVA is the absence of suitable veins in the proximity of an ideal lymphatic vessel. In situations like this, the presence of large veins with a higher diameter than the lymphatics is an alternative to consider. In these cases, end-to-side anastomosis is recommended. We describe a helpful technique to perform end-to-side LVA, using a thin catheter to create a round hole in the lateral wall of subdermal veins having the same diameter as the neighboring lymphatic that is going to be anastomosed. We also describe our personal modification of the intravascular stenting technique.

PubMed

For in depth information, please see:

Lymphatic Venous Anastomosis