Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema

Brennan, Michael J.; Miller, Timothy

doi:10.1002/(sici)1097-0142(19981215)83:12b+<2821::aid-cncr33>3.0.co;2-g

Cited by 195 publications

(133 citation statements)

References 32 publications

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“…Possible mechanisms by which affected upper-limb exercise improves or helps prevent lymphedema symptoms include that such exercise not only enhances lymphatic flow [38][39][40][41] but also improves protein resorption [42]. Lymphatic flow increases as a result of decreased intrathoracic pressure during inspiration phase [43]; this leads to speculation that increased pulmonary work during exercise may help in decreasing the lymphedema [44]. Also, affected upper-limb venous drainage has been found to be compromised most frequently in lymphedema patients [45].…”

Section: Discussionmentioning

confidence: 99%

“…Also, affected upper-limb venous drainage has been found to be compromised most frequently in lymphedema patients [45]. Stretching exercises may help reduce the soft tissue contractures and, hence, decrease the blood and lymphatic obstruction [44].…”

Section: Discussionmentioning

confidence: 99%

“…First, deep breathing is vital to ensure an adequate supply of oxygen to the tissues when the body is undergoing greater than usual exertion. Second, deep breathing creates pressure change in the abdomen, which acts like a vacuum in the thoracic cavity, helping to drain lymphatic vessels [44]. Moseley et al reported that 38 women with secondary arm lymphedema who performed 10 minutes of gentle arm exercises combined with deep breathing everyday for 1 month achieved a statistically significant reduction in arm volume of 101 mL (9.0%) [31].…”

Section: Discussionmentioning

confidence: 99%

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Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Gautam¹,

Maiya²,

Vidyasagar³

2011

JRRD

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Abstract-Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on lymphedema in clinical settings. However, there is a dearth of evidence regarding the effect of home-based exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program. Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-based exercise program. The individualized home-based exercise program led to improvement in affected upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Gautam¹,

Maiya²,

Vidyasagar³

2011

JRRD

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“…The incorporation of IPC into a multidisciplinary, therapeutic approach long has been advocated empirically by some physiotherapeutic schools. 21,22 Numerous early studies purported to demonstrate the efficacy of pumps as a sole therapeutic intervention for patients with lymphedema; [23][24][25][26][27] nevertheless, individual reports of complications and lack of efficacy 28 -30 have tended to dampen enthusiasm for the use of IPC. It was to address these unresolved questions that the current study was undertaken.…”

Section: Discussionmentioning

confidence: 99%

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Szuba

Achalu

Rockson

2002

Cancer

189

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BACKGROUNDDisruption of the lymphatic circulation through breast carcinoma‐associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma‐associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma‐associated lymphedema, prospective study of its adjunctive safety and efficacy is required.METHODSIPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma‐associated lymphedema. Twenty‐three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma‐associated lymphedema also were assessed in the maintenance phase of therapy. Twenty‐seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility.RESULTSDuring initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion.CONCLUSIONSWhen IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications. Cancer 2002;95:2260–7. © 2002 American Cancer Society.DOI 10.1002/cncr.10976

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“…Exercise, manual lymph drainage, compression garments and intermittent pump therapy are common, symptomatic treatment options requiring a good compliance and lifelong treatment [10][11][12]. Microsurgical lymphovenous or lymph to lymph vessel anastomoses are possible surgical interventions, but without significant longterm benefit to the patients [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model

Blum

Hadamitzky

Gratz

et al. 2009

Breast Cancer Res Treat

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Secondary lymphedema often develops after removal of lymph nodes in combination with radiation therapy, in particular in patients with breast cancer, inguinal cancer, cervical cancer and melanoma. No convincing treatment for the prevention and therapy of acquired lymphedema exists so far, therefore we wanted to show the reintegration of transplanted avascular lymph node fragments in the lymphatic system and positive effects of the transplanted fragments on the restoration of the lymphatic flow in this study. A total of 26 minipigs underwent lymphadenectomy of both groins. A minimum of one lymph node was retransplanted. The lymph nodes were cut into small pieces and retransplanted in the left groin (n = 17) or in both groins (n = 9). Different retransplantation techniques were investigated, transplantation of large versus small fragments, with and without capsule. The lymph flow was evaluated 5 and 8 months after surgery, using SPECT/CT and Berlin Blue. The results were confirmed by dissection. The lymph node transplants were assessed histologically. In contrast to the lymph flow in the transplanted groin, the lymph flow in the non-transplanted groin was often malfunctioning. Large lymph node fragments were found reintegrated in the lymphatic system more often than small slices of lymph node fragments. About 5 months after surgery impairment of lymph flow was seen especially after retransplantation of small slices of lymph node fragments. In seven out of eight minipigs a dermal backflow developed in the non-transplanted groin, 8 months after surgery. Only one minipig of these groups developed dermal backflow in both groins. All lymph node fragments showed an organized structure histologically. Autologous lymph node transplantation has positive effects on the regeneration of lymph vessels and restoration of lymph flow after lymphadenectomy.

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Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema

Cited by 195 publications

References 32 publications

Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model

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