A Novel Two‐Stage Surgical Approach to Treat Chronic Lymphedema

Surgical treatment of chronic lymphedema has seen significant advances. Suction‐assisted protein lipectomy (SAPL) has been shown to safely and effectively reduce the solid component of swelling in chronic lymphedema. However, these patients must continuously use compression garments to control and prevent recurrence. Microsurgery procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have been shown to be effective in the management of the fluid component of lymphedema and allow for decreased garment use. SAPL and VLNT were applied together in a two‐stage approach in two patients with chronic lymphedema after treatment for breast cancer. SAPL was used first to remove the chronic, solid component of the soft‐tissue excess. Volume excess in our patients' arms was reduced an average of approximately 83% and 110% after SAPL surgery. After the arms had sufficiently healed and the volume reductions had stabilized, VLNT was performed to reduce the need for continuous compression and reduce fluid re‐accumulation. Following the VLNT procedures, the patients were able to remove their compression garments consistently during the day and still maintain their volume reductions. Neither patient had any postoperative episodes of cellulitis. SAPL and VLNT can be combined to achieve optimal outcomes in patients with chronic lymphedema.     

Training the prepubertal and pubertal athlete

Participation of prepubertal and pubertal children in sports has increased significantly over the past decade. There is a continuing concern for their emotional and physical well-being. This review discusses concerns that coaches, trainers, parents, and athletes must confront. Young athletes are limited in their ability to perform on the playing field by both their physical and emotional maturity. Competitive sports in this age group can lead to injury and disability. Both strength training and aerobic training can have benefits for this age group but must be performed in a cautious and creative fashion. Child athletes have increased nutritional demands that require special attention. The use of performance-enhancing drugs is of special concern in this age group. Training the child athlete should be performed with the utmost concern for the athlete’s safety and well-being.     

Immediate effect of vibratory stimuli on quadriceps function in healthy adults

Introduction: The purpose of this study was to compare the effect of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function. Methods: Sixty adults were randomized to WBV, LMV, or control groups. Quadriceps function [Hoffmann (H)‐reflex, active motor threshold (AMT), motor evoked potential (MEP) and electromyographic amplitude, peak torque (PT), rate of torque development (RTD), and central activation ratio (CAR)] was assessed before and immediately after and 10 and 20 minutes after interventions. Results: WBV improved PT, CAR, AMT, EMG, and MEP amplitude, and EMG amplitude and CAR were greater than control after application. LMV improved EMG amplitude and AMT, and EMG amplitude was greater than control after application. AMT remained lower 10 and 20 minutes after WBV and LMV. No differences were noted between LMV and WBV. Vibration did not influence H‐reflex or RTD. Conclusions: WBV and LMV increased quadriceps function and may be used to enhance the efficacy of strengthening protocols. Muscle Nerve 54 : 469–478, 2016