Synergic Effect of Compression Therapy and Controlled Active Exercises Using a Facilitating Device in the Treatment of Arm Lymphedema

2012

Maria de Fátima Guerreiro Godoy,  Maria Regina Pereira,  Antonio Helio Oliani,  and  Jose Maria Pereira de Godoy

ABSTRACT

^{Trial design:} 

^{A randomized controlled trial was performed to evaluate the effect of the combination of compression therapy with active exercising using a facilitating apparatus on arm lymphedema.} 

^Method:

^{Twenty women with a mean age of 63.3 years were evaluated; all had arm lymphedema resulting from breast cancer treatment. The inclusion criterion was a difference of 200 mL in size between arms. The apparatus used, called 'pulley system', is a vertical iron wheel fixed on a support at a distance of 10 cm from the patient's body. Participants were submitted to two series of active exercises using this facilitating device, one series using a compression sleeve and the other without.} 

^{Each series consisted of four 12-minute sessions of exercises separated by 3-minute rest intervals. Volumetry was performed before and after each series of exercises. The paired t-test was utilized for statistical analysis (p-value < 0.05).} 

^Results: 

^{A significant mean reduction (p-value < 0.007) and non-significant mean increase (p-value < 0.2) in volumes were observed during exercising with and without compression, respectively.} 

^Conclusion: 

^{Controlled active exercising utilizing a facilitating apparatus while wearing a compression sleeve reduces the size of  lymphedematous arms.}

^{Read the full text article:}

^{NIH - International Journal of Medical Sciences}

Complications of Autologous Lymph-node Transplantation for Limb Lymphoedema.

2012

Vignes S, Blanchard M, Yannoutsos A, Arrault M.

Source

Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris, France. Electronic address: stephane.vignes@cognacq-jay.fr.

Abstract

OBJECTIVE:

This study aims to assess potential complications of autologous lymph-node transplantation (ALNT) to treat limb lymphoedema.

DESIGN:

Prospective, observational study.

METHOD:

All limb-lymphoedema patients, followed up in a single lymphology department, who decided to undergo ALNT (January 2004-June 2012) independently of our medical team, were included.

RESULTS:

Among the 26 patients (22 females, four males) included, 14 had secondary upper-limb lymphoedema after breast-cancer treatment and seven had secondary and five primary lower-limb lymphoedema. Median (interquartile range, IQR) ages at primary lower-limb lymphoedema and secondary lymphoedema onset were 18.5 (13-30) and 47.4 (35-58) years, respectively. Median body mass index (BMI) was 25.9 (22.9-29.3) kg m(-2). For all patients, median pre-surgery lymphoedema duration was 37 (24-90) months. Thirty-four ALNs were transplanted into the 26 patients, combined with liposuction in four lower-limb-lymphoedema patients. Ten (38%) patients developed 15 complications: six, chroniclymphoedema (four upper limb, two lower limb), defined as ≥2-cm difference versus the contralateral side, in the limb on the donor lymph-node-site territory, persisting for a median of 40 months post-ALNT; four, post-surgical lymphocoeles; one testicular hydrocoele requiring surgery; and four with persistent donor-site pain. Median (IQR) pre- and post-surgicallymphoedema volumes, calculated using the formula for a truncated cone, were, respectively, 1023 (633-1375) ml (median: 3 (1-6) months) and 1058 (666-1506) ml (median: 40 (14-72) months; P = 0.73).

CONCLUSION: ALNT may engender severe, chronic complications, particularly persistent iatrogenic lymphoedema. Further investigations are required to evaluate and clearly determine its indications.

European Journal of Vascuar & Endovascular Surger

The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of lymphedema severity and response to CDP in breast cancer-related lymphedema (BCRL).

The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of lymphedema severity and response to CDP in breast cancer-related lymphedema (BCRL).

Jan 2013

Liao SF, Li SH, Huang HY, Chen ST, Kuo SJ, Chen DR, Wei TS.

Source

Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: sueliao3@gmail.com.

Abstract

BCRL is the most common morbidity in women with breast cancer. We performed a retrospective analysis of 107 BCRL patients to identify the efficacy of CDP and the predictors of lymphedema severity and response to CDP. The patients received 12 sessions of CDP, the duration of lymphedema was 22.4 months, and 56% of BCRL occurred within 2 years after surgery. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV), was 27.7% and 14.9%. The baseline PEV was correlated with the duration of lymphedema. The CDP efficacy, percentage reduction of excess volume (PREV), was 50.5%, and was correlated with PEV, duration of lymphedema and age. Baseline lymphedemaseverity was the most important predictive factor for CDP efficacy. The breast cancer therapy characteristics did not affect PEV or PREV. This study showed the effectiveness of an intensive CDP interventions. The key to predicting successfullymphedema treatment is the baseline PEV.

Elsevier

Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center.

Dec 2012

Olszewski WL.

Source

Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland. Electronic address: wlo@cmdik.pal.pl.

Abstract

RATIONALE:

The use of microsurgical lymphovenous shunts is one of the generally accepted treatments for limblymphedema.

AIM:

The 45-year personal experience of one surgeon in indications, technique and results of lymphovenous shunt operations in lower limb lymphedema of varying etiology is presented.

MATERIAL:

One thousand three hundred patients were followed up in the period 1966-2011. Patients were classified into groups according to the etiology of lymphedema as postinflammatory/posttraumatic, postsurgical, idiopathic and hyperplastic. Decrease in limb circumference, heaviness and pain, and increase in joint flexing were evaluated.

RESULTS:

The most satisfactory results, reaching 80-100% improvement, were obtained in the congenital non-hereditary hyperplastic lymphedema group, with large lymphatics not previously damaged by infection. Results were also satisfactory in the group of cancer patients after iliac lymphadenectomy, reaching 80%. A less satisfactory outcome was observed in the postinflammatory group, not exceeding 30-40%. In idiopathic lymphedema results were satisfactory in only a few cases.

CONCLUSIONS:

Patients with lymphedema with local segmental obstruction but still partly patent distal lymphatics and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels present satisfactory results.

ESVS

Can I Prevent Lymphedema?

Can I Prevent Lymphedema?

It seems to be quite “fashionable” lately for website to put out pages on “How to Prevent Lymphedema.” As a lymphedema patient of almost 60 years, I find it somewhat dishonest (to say the least) for anyone to be claiming a way of doing this. It simply is not true. There is absolutely no scientific or medical evidence to support that claim and it gives false hopes to people who are desperate for some type of hope and help.

You can not absolutely prevent lymphedema if your lymphatic system has been damaged or compromised and you are at risk. The only way to “prevent” lymphedema is to have the lymph systemm regrown or repaired where it has been damaged. But there are certain steps you can take that can that can lessen your chances of getting it or will help lessen the severity of it should it happen.

While it is not possible to prevent lymphedema, you can and should take steps to lesson the possibility and/or to lessen its impact.

Pat

My Life with Lymphedema and Lymphoma

Risk Factors for Lymphedema

Who is at risk for lymphedema? Anyone who has one or more of the following factors can acquire lymphedema.

• Lymph node removal for biopsies

• Serious infections that include Lymphangitis, cellulitis or erysipelas

• Deep invasive wounds that might tear, cut or damage the lymphatics

• Radiation treatments, especially ones that are focused in areas that might contain “clusters” of lymph nodes

• Morbid obesity can cause secondary lymphedema by “crushing” the lymphatics

• Serious burns, even intense sunburn

• Infection of the microscopic parasite filarial larvae, though this is more common in tropical countries

• Trauma injuries such as those experienced in an automobile accident that severly injures the leg and the lymph system.

• For primary lymphedema any person who has a family history of unknown swelling of a limb
  
  

  Eighteen Steps to Prevention of Lymphedema

  1. Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers or chest wall (consult with your doctor immediately).

  2. Never allow an injection or a blood drawing in the affected arm(s).

  3. Have blood pressure checked in the unaffected arm.

  4. Keep the edemic arm, or “at-risk” arm spotlessly clean. Use lotion (Eucerin, Nivea) after bathing. When drying it, be gentle, but thorough. Make sure it is dry in any creases and between the fingers.

  5. Avoid vigorous, repetitive movements against resistance with the affected arm (scrubbing, pushing, pulling).

  6. Avoid heavy lifting with the affected arm. Never carry heavy handbags or bags with over-the-shoulder straps.

  7. Do not wear tight jewelry or elastic bands around affected fingers or arm(s).

  8. Avoid extreme temperature changes when bathing, washing dishes, or sunbathing (no 1sauna or hot tub). Keep the arm protected from the sun.

  9. Avoid any type of trauma (bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches).

  10. Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury.

  11. When manicuring your nails, avoid cutting your cuticles (inform you manicurist).

  12. Exercise is important, but consult with your therapist. Do not overtire an arm at risk; if it starts to ache, lie down and elevate it. Recommended exercises: walking, swimming, light aerobics, bike riding, and specially designed ballet or yoga. (Do not lift more than 12 lbs.)

  13. When traveling by air, patients with lymphedema must wear a compression sleeve. Additional bandages may be required on a long flight.

  14. Patients with large breasts should wear light breast prostheses (heavy prostheses may put too much pressure on the lymph nodes above collar bone). Soft pads may have to be worn under the bra strap. Wear a well-fitted bra that is not too tight and with no wire support.

  15. Use an electric razor to remove hair from axilla. Maintain electric razor properly replacing heads as needed.

  16. Patients who have lymphedema should wear a well-fitted compression sleeve during all waking hours. At least every four to six months see your therapist for follow-up. If the sleeve is too loose, most likely the arm circumference has reduced or the sleeve is worn.

  17. Warning: If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected arm could be the beginning of lymphedema or a worsening of lymphedema.

  18. Maintain your ideal body weight through a well-balanced, low sodium, high-fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid; rather this will weaken the connective tissue and worsen the condition. The diet should contain protein that is easily digested, such as chicken and fish.

  
  

  See also: Lymphedema Risk Reduction Practices

  National Lymphedema Network

Lymphedema Strategies for Investigation and Treatment: A Review

Lymphedema Strategies for Investigation and Treatment: A Review

Oct/Dec 2012

Pankaj Tiwari MD 
Michelle Coriddi MD 
Susan Lamp BSN, RN, CPSN 

Plastic Surgical Nursing

**For information only.  There is much controversery regarding surgical treatment for lymphedema**

Abstract

The goal of this article was to define lymphedema as a disease entity, to introduce the American Lymphedema Framework Project, and to summarize current surgical strategies on the horizon in the surgical treatment of lymphedema.

LYMPHEDEMA DEFINED

Alongside the arterial and venous vasculature, the lymphatic system is a part of the circulatory system. Lymphatic channels primarily regulate the flow of fluid in the interstitium (Ellis, 2006). Under normal conditions, venous capillaries reabsorb 90% of the fluid in the tissues, and lymphatic channels absorb the remaining 10% of lymph fluid, proteins, and other molecules (Warren, Brorson, Borud, & Slavin, 2007). Lymphatic fluid passes to regional lymph node basins. Ultimately, the lymphatic fluid is transported back into the subclavian vein to enter the venous system via the thoracic duct.

Lymphedema is an external or internal manifestation of lymphatic insufficiency and deranged lymph transport (International Society of Lymphology, 2009). This insufficiency causes an accumulation of protein-rich interstitial fluid, leading to distention, proliferation of fatty tissue, and progressive fibrosis. Skin changes such as thickening and hair loss may occur. Progressive lymphedema without adequate management can lead to functional impairment, compromised quality of life, and deformity. Clinically, lymphedema is noted as swelling of the involved extremity. The head and neck, breast, or genitalia may also be affected (McWayne, & Heiney, 2005; Rockson, 2010; Smeltzer, & Stickler, 1985).

Lymphedema is generally classified as either primary or secondary. Primary lymphedema (hereditary) is related to congenital malformation of the lymphatic channels. Secondary lymphedema results from disruption to the lymphatic system. Primary lymphedema can result from any one of a number of disorders that may be sporadic or hereditary. Syndromes such as Milroy's disease and Prader-Willi syndrome have lymphedema as an element of their clinical manifestations to varying degrees. The estimated prevalence of primary lymphedema is 1.15 in 100,000 persons under the age of 20 years Milroy's Disease (Smeltzer & Stickler, 1985). In children, the two main causes are Milroy's disease and lymphedema distichiasis (International Society of Lymphology, 2009).

Secondary lymphedema is a consequence of removal or damage to lymph nodes, fibrosis of the nodes (postradiotherapy), and trauma or infection secondary_lymphedema Rockson, 2010). Upper extremity lymphedema is commonly associated with the treatment of breast cancer. The degree of lymphedema has been well recognized to correlate with the number of lymph nodes that have been removed and the extent of radiotherapy to the axillary region. Lower extremity lymphedema is most often seen in survivors of uterine and prostate cancer, as well as melanoma and lymphoma survivors (Meneses & McNees, 2007). Most cancer survivors develop lymphedema within 3 years of treatment (Petrek, Senie, Peters, & Rosen, 2001).

In addition to cancer ablation, side effects of advanced diseases such as congestive heart failure, neurological and liver disease, and end-stage renal disease can cause chronic edema. An increase in the bariatric population has also seen an increase in lymphedema incidence. Lympedema caused by the parasite wucheria bancrofti and transmitted by mosquitoes remains the most common cause of lymphedema worldwide. Unfortunately, no strategies employed to prevent the onset of lymphedema have proven fruitful to date. The term chronic edema has been adopted by European investigators to define a population of patients with long-standing edema (>3 months). Prevalence estimates for chronic edema are between 1.3 and 1.5 per thousand.

New clinical data suggest that some patients may have a primary disposition to lymphedema but that this first becomes clinically evident after a secondary eliciting event (Rockson, 2010). Lymphedema tarda is defined as debut after the age of 35 years. It is often associated with an eliciting factor such as trauma or an inflammatory reaction (Kerchner, Fleischer, & Yosipovitch, 2008).

Complete text:

Nursing Center

Microsurgical Techniques for the Treatment of Breast Cancer-related Lymphedema: a Systematic Review.

Dec 2012

Penha TR, Ijsbrandy C, Hendrix NA, Heuts EM, Voogd AC, von Meyenfeldt MF, van der Hulst RR.

Source

Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.

Abstract

Background 

Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related lymphedema (BCRL).

Methods 

A search was conducted for articles published from January 2000 until January 2012. Only studies on secondary lymphedema after breast cancer treatment and those examining the effectiveness of microsurgery were included.

Results 

No randomized clinical trials or comparative studies were available. Ten case-series met inclusion criteria: (composite) tissue transfer (n = 4), lymphatic vessel transfer (n = 2), and derivative microlymphatic surgery (n = 4). Limb volume/circumference reduction varied from 2 to 50% over a follow-up time ranging from 1 to 132 months. Postoperative discontinuation rates of conservative therapy were only reported after composite tissue transfer, ranging from 33 to 100% after 3 to 24 months. Clear selection criteria for lymphatic surgery and lymphatic flow assessment were absent in most studies.

Conclusion 

We identified important methodological shortcomings of the available literature. Evidence acquired through comparative studies with uniform patient selection is lacking. Consistent positive findings with regards to limb volume reduction and limited complications are reasons to further explore these techniques in methodologically superior studies.

Thieme