Retrospective trial of complete decongestive physical therapy for lower extremity secondary lymphedema in melanoma patients

Background  

Melanoma is a malignant tumour of melanocytes, which are found predominantly in skin, and at least 10–45% of patients develop secondary lymphedema (SL).     

Treatment of secondary lymphedema of the arm with physical decongestive therapy and sodium selenite: a review

Secondary lymphedema (LE) in the proximal extremities develop with relatively high frequency in cancer patients after tumor resection, lymph-node obliteration, and/or postoperative irradiation. Physical therapy combined with manual or mechanical lymph drainage and compression bandaging provides symptomatic relief but does prevent the progression of degenerative changes in the affected tissues. As biochemical studies have linked these changes significantly to the excessive generation of oxygen radicals in the affected tissues, LE therapy should aim to eliminate oxygen radical production. Because selenium is a functional component of antioxidant enzymes, has anti-inflammatory properties, and reduces the expression of endothelial cell adhesion molecules, its effect was investigated in postmastectomy patients with LE of the arm. Sodium selenite administered orally in isotonic solution (selenase) at oral dosages of 800 microg Se/day on days 1 through 4 and 500 microg Se/day on days 5 through 28 produced a spontaneous reduction in LE volume and normalized blood parameters in a manner consistent with diminished oxygen radical production. In a randomized, placebo-controlled, double-blind study with postmastectomy LE patients undergoing combined physical decongestion therapy (CPDT), selenite at similar dosages increased the efficacy of CPDT and improved the mobility and heat tolerance of the affected extremity. The patients in this study received 1000 microg of Se/day orally during the first week, 300 microg Se/day during the second and third weeks, and a maintenance dose of 100 microg Se/day during 3 months of follow-up. All patients remained erysipelas-free during the 3 weeks of CPDT and the 3-month follow-up period. Based on the available evidence, supplementation with sodium selenite in isotonic solution is judged to be a valuable and safe extension of the physical decongestive therapy of LE.     

乳腺癌相关淋巴水肿患者综合消肿治疗的居家护理

总结44例乳腺癌相关淋巴水肿患者综合消肿治疗的居家护理措施。护理要点包括：由专科护士指导重复测量患肢周径,提高周径测量的准确性;开展多种形式的健康宣教,提高手动淋巴引流手法的准确性;指导压力工具在特殊部位的使用;注重护患沟通,做好心理护理。44例乳腺癌相关淋巴水肿患者通过4周综合消肿治疗的居家护理,患肢周径缩小,疼痛、活动度等方面均得到不同程度的缓解。     

Physical therapy management of primary lymphedema in the lower extremities: A case report

ABSTRACT

Lymphedema is the tissue fluid accumulation that arises as a consequence of impaired lymphatic drainage. Lymphedema can result from either congenital (primary) or acquired (secondary) anomalies. Primary lymphedema affects 1–2 million people in the United States. Women are more affected by this disorder than men. The management of lymphedema by physical therapists usually includes a combination of skin care, external pressure, isotonic exercise, and massage. This case report describes the course of treatment for a 24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical therapy intervention were as follows: 1) to reduce total limb girth circumference for both lower extremities; 2) to improve skin texture; 3) to promote independence with skin care to reduce the risk of infection; and 4) to facilitate independence with self-management. Following intervention, the patient met and exceeded all goals to decrease limb circumference. She had minimal fibrosis in the lower extremities, and she exhibited no signs and/or symptoms of infection. Decongestive lymphedema therapy was effective in treating this patient with primary lymphedema of the lower extremities. Continuous maintenance is required to ensure that the patient's limb size continues to reduce.     

Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema

[Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema.Key words: Breast cancer, Manual lymphatic drainage, Post mastectomy lymphedema     

Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report

[Purpose] We report the case of a pediatric patient with congenital lymphedema treated with complex decongestive physical therapy and low-level laser therapy. [Subjects and Methods] The patient was a 2 year-old girl who had lymphedema in the left upper limb since birth. Complex decongestive physical therapy and low-level laser therapy were administered for 7 sessions. [Results] The circumferences of the middle of the forearm, elbow joint, wrist, and hand of the left upper limb decreased 0.5, 3, 0.5, and 2 cm, respectively. The moisture content of the left upper limb decreased 70 mL (6.66%), while moisture ratio increased by 0.007%. [Conclusion] Complex decongestive physical therapy and low-level laser therapy are effective for reducing lymphedema in pediatric patients.Key words: Lymphedema, Complex decongestive physical therapy, Low-level laser therapy     

Extracorporeal shock wave therapy for management of chronic ulcers in the lower extremities

Management of chronic ulcers in the lower extremities is still a challenge for patients and health providers. Recent studies showed extracorporeal shock waves (ESW) as effective in stimulating growth factors, inducing angiogenesis and healing of fractures and injuries. This study was planned to investigate the opportunity of introducing the ESW in the treatment of chronic wounds. Thirty consecutive patients with chronic posttraumatic, venous and diabetic ulcers, unresponsive to conservative or advanced dressing treatments, were counseled about the use of ESW as alternative treatment for their wounds. Thirty-two wounds were treated and 16 wounds healed completely within six sessions of ESW. In all of the nonhealed wounds, decrease of the amount of exudates, increased percentage of granulation tissue compared with fibrin/necrotic tissue and decrease of wounds' size were statistically significant after four to six sessions of ESW (p < 0.01). Significant decrease of pain was reported (p < 0.001). Comparison with a control group of 10 patients with chronic ulcer treated on the basis of regular dressings confirmed the statistical significant improvement in the healing process (p < 0.01). ESW therapy seems to be a safe, feasible and cost-effective treatment for chronic ulcers in the lower extremities. Further research and clinical trials are necessary to evaluate dose and time intervals of sessions to standardize a protocol of treatment in the management of chronic wounds.     

Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lymphoedema associated with rheumatoid arthritis: A case report

A 54-y-old patient with rheumatoid arthritis (RA) and bilateral lower-limb lymphoedema is presented. Complete decongestive physical therapy (CDP) is the cornerstone of the management programme in all patients suffering from lymphoedema associated with RA, but it is not clear which therapy is the most effective in decreasing the oedema. We report on a patient with bilateral lower-limb lymphoedema associated with RA who, after receiving etanercept and CDP, showed moderate improvement. There is little information on the benefit of etanercept therapy for the extra-articular manifestations of RA. Further research is necessary to confirm the beneficial effect of etanercept and CDP.     

Complex decongestive therapy and taping for patients with postmastectomy lymphedema: A randomized controlled study

PurposeThe purpose of our study was to investigate the effects of Kinesio Taping^® Application with Complex Decongestive Therapy (CDT) in patients with lymphedema.Materials and Methods45 patients were randomly divided into 3 groups (CDT including Bandage, CDT including Bandage + Kinesio Tape^®, CDT including Kinesio Tape^® without bandage). Assessments included the severity of the symptoms such as pain, discomfort, heaviness, tension, stiffness and weakness. Bilateral circumference measurements were done for evaluation of the edema.ResultsSymptoms were decreased in all three groups (p < 0.05). CDT was found effective only during treatment in arm volume (p < 0.05). Kinesio Taping^® applied with CDT had effect of decreasing edema after 10 days of treatment period (p < 0.05) and for control period (p < 0.05). Only the application of Kinesio Taping^® group also had significant decrease at edema (p < 0.05).ConclusionKinesio Taping^® Application along with CDT may have a better effect on decreasing lymphedema which can stimulate the reduction of edema for long term effects.     

Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial

Background  

Lymphedema as a result of curative surgery for breast cancer can lead to long-term morbidity. Decongestive lymphatic therapy (DLT) is recognized as an optimal management strategy for patients with moderate symptomatologies, but there is little data in regard to the most effective means of providing compression therapy within a DLT protocol. We conducted a randomized trial of two forms of compression therapy within the initial treatment phase of a DLT protocol for breast cancer-related lymphedema.     

Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.     

渐增压力治疗仪辅助治疗下肢淋巴水肿的效果观察和护理

总结了探讨渐增压力治疗仪辅助治疗下肢淋巴水肿的疗效和护理.对50例淋巴水肿患者在常规治疗的基础上加用渐增压力治疗仪治疗,并配合相应的护理措施,进行健康指导.     

VEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema

Although lymphedema is a common clinical condition, treatment for this disabling condition remains limited and largely ineffective. Recently, it has been reported that overexpression of VEGF-C correlates with increased lymphatic vessel growth (lymphangiogenesis). However, the effect of VEGF-C-induced lymphangiogenesis on lymphedema has yet to be demonstrated. Here we investigated the impact of local transfer of naked plasmid DNA encoding human VEGF-C (phVEGF-C) on two animal models of lymphedema: one in the rabbit ear and the other in the mouse tail. In a rabbit model, following local phVEGF-C gene transfer, VEGFR-3 expression was significantly increased. This gene transfer led to a decrease in thickness and volume of lymphedema, improvement of lymphatic function demonstrated by serial lymphoscintigraphy, and finally, attenuation of the fibrofatty changes of the skin, the final consequences of lymphedema. The favorable effect of phVEGF-C on lymphedema was reconfirmed in a mouse tail model. Immunohistochemical analysis using lymphatic-specific markers: VEGFR-3, lymphatic endothelial hyaluronan receptor-1, together with the proliferation marker Ki-67 Ab revealed that phVEGF-C transfection potently induced new lymphatic vessel growth. This study, we believe for the first time, documents that gene transfer of phVEGF-C resolves lymphedema through direct augmentation of lymphangiogenesis. This novel therapeutic strategy may merit clinical investigation in patients with lymphedema.     

The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema

Background  

Breast-cancer-related lymphedema (BCRL) is a chronic disease, and currently there is no definitive treatment for it. There are some therapeutic interventions targeted to decrease the limb swelling and the associated problems. Low-level laser therapy (LLLT) has been used in the treatment of post-mastectomy lymphedema since 2007 in the US. The aim of this study is to review our short-term experience with LLLT in the treatment of BCRL.     

Evaluation of the lower extremities

The Octoson, an automated, water-delay ultrasonic scanner, that provides excellent demonstration of the normal anatomy of subcutaneous tissues, muscles, and blood vessels, was used to evaluate the lower extremities of 25 patients. A variety of pathologic conditions were demonstrated, including popliteal cysts, hematomas, an abscess, and an aneurysm.