Conservative treatment of lymphedema: the state of the art

Bergmann, Anke; Baiocchi, Jaqueline Munaretto Timm; Andrade, Mauro Figueiredo Carvalho de

doi:10.1590/1677-5449.200091

Cited by 19 publications

(14 citation statements)

References 75 publications

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“…Currently, complex decongestive therapy (CDT), which includes elements such as manual lymphatic drainage, compression therapy, remedial exercise, and skin care, is the standard therapy for BCRL [13,[35][36]. Studies have found that CDT is effective in treating BCRL, however, the treatment effect varies between individuals, due to many factors such as the severity and duration of lymphedema.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough

Huang

et al. 2023

Preprint

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Purpose: Complex decongestive treatment (CDT) and extracorporeal shockwave therapy (ESWT) have been shown to be effective in the treatment of early-stage breast-cancer-related lymphedema (BCRL) but less so for later-stage. This study examined the effects of ESWT on late-stage BCRL (Stages IIb and III) as an adjunct treatment after prolonged CDT failed. Patients and Methods: 11 female patients with BCRL who had undergone at least 6 months of CDT monotherapy without measurable effects received ESWT 3 times a week for 12 weeks with concurrent CDT. Limb circumference and the thicknesses of the skin, subcutaneous tissue, and muscle layers were measured using a measuring tape and ultrasound, respectively, in the most edematous regions of both the forearm and upper arm. Results: After the addition of ESWT to CDT, the mean circumference, thickness of the skin layer, and the thickness of the subcutaneous tissue layer of the affected limb decreased significantly (p < 0.05), while the mean thickness of muscle on the affected limb increased slightly but not significantly (forearm, p = 0.348; upper arm, p = 0.100). On the unaffected limb, no significant changes were measured (p > 0.05). Conclusions: ESWT as an adjunct treatment to CDT monotherapy after a period of 6 months showed significant reductions in distal and proximal upper limb circumference, skin layer thickness, and subcutaneous tissue layer thickness in patients suffering from prolonged late stage (IIb and III) BCRL, suggesting that the combination therapy was effective on severe BCRL and fibrotic lesions that could not be effectively treated by CDT alone.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough

Huang

et al. 2023

Preprint

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“…Both conservative and surgical techniques are utilized in the treatment of lymphedema. 25 Complete (also known as complex) decongestive therapy is composed of hygiene precautions, lymphatic drainage, compression mechanisms, and exercise. 25,26 It has been shown that Complete decongestive therapy leads to effective reductions in limb volume, improves patient quality of life, and maintains high patient satisfaction, making this treatment the gold standard.…”

Section: Discussionmentioning

confidence: 99%

“…25 Complete (also known as complex) decongestive therapy is composed of hygiene precautions, lymphatic drainage, compression mechanisms, and exercise. 25,26 It has been shown that Complete decongestive therapy leads to effective reductions in limb volume, improves patient quality of life, and maintains high patient satisfaction, making this treatment the gold standard. 27,28 Intermittent pneumatic compressions are cuffs that are intermittently pressurized to replicate the natural effects of skeletal muscle contracting around lymphatic and blood vessels.…”

Section: Discussionmentioning

confidence: 99%

“…31 In addition, extracorporeal shock wave therapy has shown to lead to reductions in lymphedema and improve patient quality of life, which makes the therapy a promising treatment modality, 32 Finally, taping has demonstrated to be another conservative treatment by being placed along lymphatic tracks and facilitating the absorption of interstitial fluid to less congested lymphatic pathways. 25,33 However, taping is contraindicated in patients with skin infections, renal failure, diabetes, and peripheral vascular disease, making this a supplementary treatment. 34 For patients who have had minimal improvement in swelling with conservative management, surgical treatment is and may consist of direct resection of involved tissue, suction-assisted lipectomy, lymphaticovenous anastomosis, or vascularized lymph node transfer surgery.…”

Section: Discussionmentioning

confidence: 99%

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May-Thurner Syndrome and Lymphedema Reconstruction

Gupta

Mathijs

Hart

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: May-Thurner syndrome (MTS) is an anatomical variant that results in compression of the left common iliac vein by the right common iliac artery. Although often asymptomatic, lower extremity swelling/edema, deep venous thrombosis, post-thrombotic syndrome, and eventual lymphedema (due to long-standing venous obstruction) can develop. The clinical management of patients presenting for lymphedema surgery with concomitant or undiagnosed MTS is not well described. Methods: This review investigates two patients who were evaluated for unilateral lower extremity lymphedema, both of whom were subsequently diagnosed with MTS. Standard imaging (including lymphoscintigraphy, indocyanine green lymphangiography, and magnetic resonance venography) were performed to identify proximal venous obstruction. Treatment was accomplished using vascular surgical management, including stenting of the iliac vein before lymphedema reconstruction with vascularized lymph node transfer and multiple lymphovenous bypass. Results: Both patients we examined in this review had improvement of lymphedema with vascular surgical management. Literature review reveals that MTS has an incidence as high as 20% in the population, although commonly unidentified due to lack of symptomatology. Conclusions: There are no studies documenting the incidence of MTS in patients referred for lymphedema surgical management. Routine studies should be obtained to screen for proximal venous obstruction in patients presenting for surgical management of lower extremity lymphedema. Additional research is needed regarding the approach to managing patients with both MTS and lymphedema. Careful observational and prospective studies may elucidate the appropriate time interval between venous stenting and lymphedema microsurgical reconstruction.

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“…Symptom management can be conservative or surgical, HRQoL is often considered in the choice of the therapeutic modality [ 7 , 8 ]. The standard conservative treatment is Complete Decongestive Therapy (CDT) or Combined Physical Therapy (CPT), which consists of a combination of techniques that includes skin care, manual lymphatic drainage, joint mobility exercises, compression garments and multilayer bandages; however, there are no solid data to recommend its universal use due to the characteristics of the treatment itself [ 9 , 10 , 11 ]. The prescription of compression garments for lymphedema is very varied due to the lack of evidence to support the treatment [ 12 ], whose use neither provides benefit nor is contraindicated during the practice of physical activity [ 13 ], and it can cause irritation, skin discomfort and pain, and even soft tissue and nerve injuries [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Activity-Oriented Propioceptive Antiedema Therapy on the Health-Related Quality of Life of Women with Upper-Limb Lymphedema Secondary to Breast Cancer—A Randomized Clinical Trial

Muñoz-Alcaraz

Torres

Jiménez-Vílchez

et al. 2022

JCM

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Background: Alterations derived from lymphedema in the upper-limb secondary to breast cancer-related lymphedema (BCRL) decrease the health-related quality of life (HRQoL), but there is limited evidence of the impact of the different interventions on it. The aim of this research was to compare the effect of conventional treatment with another treatment based on Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) on HRQoL in women diagnosed with BCRL. Methods: A prospective clinical study was designed with two parallel arms. The study population consisted of women diagnosed with BCRL in stage I and II, belonging to different institutions in Córdoba and Aragon, Spain. Sociodemographic and HRQoL-related variables, pain, tightness, heaviness and functionality were obtained before and after treatments. Results: 51 women participated in the study, 25 received the conventional treatment and 26 the TAPA, with a mean age of 59.24 ± 9.55 years. HRQoL was significantly related to upper-limb function and pain on the participants’ affected side. In addition, covariance analysis (ANCOVA) showed that the TAPA treatment interfered less in the performance of activities of daily life and produced significant improvements in the social dimension of HRQoL. Conclusions: the non-use of compressive elements in the rehabilitative treatment of the BCRL that is proposed with TAPA improves aspects such as self-image and participation in social and recreational activities.

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Conservative treatment of lymphedema: the state of the art

Cited by 19 publications

References 75 publications

Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough

Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough

May-Thurner Syndrome and Lymphedema Reconstruction

Impact of Activity-Oriented Propioceptive Antiedema Therapy on the Health-Related Quality of Life of Women with Upper-Limb Lymphedema Secondary to Breast Cancer—A Randomized Clinical Trial

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