PurposePneumatic compression devices (PCDs) are used in the home setting as adjunctive treatment for lymphedema after acute treatment in a clinical setting. PCDs range in complexity from simple to technologically advanced. The objective of this prospective, randomized study was to determine whether an advanced PCD (APCD) provides better outcomes as measured by arm edema and tissue water reductions compared to a standard PCD (SPCD) in patients with arm lymphedema after breast cancer treatment.MethodsSubjects were randomized to an APCD (Flexitouch system, HCPCS E0652) or SPCD (Bio Compression 2004, HCPCS E0651) used for home treatment 1 h/day for 12 weeks. Pressure settings were 30 mmHg for the SPCD and upper extremity treatment program (UE01) with standard pressure for the APCD. Thirty-six subjects (18 per group) with unilateral upper extremity lymphedema with at least 5% arm edema volume at the time of enrollment, completed treatments over the 12-week period. Arm volumes were determined from arm girth measurements and suitable model calculations, and tissue water was determined based on measurements of the arm tissue dielectric constant (TDC).ResultsThe APCD-treated group experienced an average of 29% reduction in edema compared to a 16% increase in the SPCD group. Mean changes in TDC values were a 5.8% reduction for the APCD group and a 1.9% increase for the SPCD group.ConclusionThis study suggests that for the home maintenance phase of treatment of arm lymphedema secondary to breast cancer therapy, the adjuvant treatment with an APCD provides better outcomes than with a SPCD.
Assessing local tissue water using tissue dielectric constant (TDC) values is useful to evaluate oedema/lymphoedema features and their change. Knowledge of anatomical site and tissue depth dependence of TDC values could extend this method's utility. Our goal was to compare TDC values obtained at anatomically paired sites and to investigate their depth dependence. In 22 women (12 awaiting surgery for breast cancer and 10 cancer-free control subjects), four sites (mid-forearm, mid-biceps, axilla and lateral thorax) on both body sides were measured with a 2.5-mm sampling depth probe. Also, at forearm, four different probes with sampling depths of 0.5, 1.5, 2.5 and 5 mm were used. TDC values range between 1 for zero water to 78.5 for 100% water. Site comparisons showed TDC values (mean+/-SD) to be largest at axilla (36.4+/-8.9), least at biceps (21.6+/-3.5) and not different between forearm and thorax (24.3+/-4.0 versus 24.8+/-5.0). Group comparisons showed slightly greater values in patients at forearm and biceps (P<0.05) but no group difference at other sites. Dominant-non-dominant side comparisons showed no significant difference in paired-TDC values in either group at any site. Forearm TDC values decreased with increasing depth from 36.4+/-4.8 at 0.5 mm to a minimum of 21.4+/-3.9 at 5.0 mm, with a sharp decline between 1.5 and 2.5 mm. The composite findings suggest that TDC measurements have the necessary features for usefully assessing oedema/lymphoedema and its change on limbs and at body sites not routinely amenable to assessment by other techniques. The depth dependence feature provides additional flexibility to investigate oedematous or lymphoedematous conditions.
The results indicate that segment lengths of 4 cm generally are not needed to obtain adequate estimates of leg volume changes. Both limb volumes should be measured to properly assess therapeutic outcomes in patients with unilateral limb lymphedema.
Previous reports described the use of average tissue dielectric constant (TDC) measurements to assess local tissue water and its change. Our goal was to determine if a single TDC measurement could be used in place of the average of multiple measurements. The comparison criteria used to test this was the extent to which single and averaged measurements yielded similar TDC values in both normal and lymphedematous tissue. Measurements were made in two groups of women; a control group (n = 20) and a group with unilateral arm lymphedema (n = 10). In the control group, TDC was measured to multiple depths (0.5-5.0 mm) on both ventral forearms and to a depth of 2.5 mm on the lateral thorax on both body sides. In the lymphedematous group, TDC was measured on both ventral forearms to a depth of 2.5 mm. Results showed that the 95% confidence interval for differences between single and averaged TDC values was less than +/-1 TDC unit and that the limits of agreement between methods was less than +/-2.5 TDC units (+/-6.5%) for each condition, site and depth measured. This finding suggests that where this level of agreement is acceptable suitable clinical assessments can be made using a single TDC measurement.
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