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

Iwersen, Lisandra Fossari; Sperandio, Fabiana Flores; Toriy, Ariana Machado; Palú, Marina; Luz, Clarissa Medeiros da

doi:10.1080/09593985.2016.1247935

Cited by 24 publications

(12 citation statements)

References 31 publications

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“…Tradicionalmente, el tratamiento conservador es el pilar fundamental y la forma inicial de tratamiento del linfedema. La terapia descongestiva compleja (TDC) debe ser realizada por un profesional especializado en linfedema, siendo más efectiva en etapas tempranas 25 . Tiene una fase inicial reductiva (3-8 semanas) que consiste en el drenaje linfático manual, vendaje multicapa, ejercicios terapéuticos, cuidado de la piel, educación y autocuidado, compresión elástica; y una fase de mantenimiento que contempla el autodrenaje linfático permanente, ejercicios, cuidado de la piel y uso de prendas/vendaje de compresión 25 .…”

Section: Tratamiento Conservadorunclassified

Linfedema de extremidades inferiores secundario al tratamiento oncológico: actualización en el diagnóstico y tratamiento quirúrgico

Pereira

Yamamoto

2019

Rev. cir.

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Lower extremity lymphedema secondary to oncological treatment: update on diagnosis and surgical treatment Lower extremities secondary lymphedema is the accumulation of protein-rich fluid in the interstitium as a consequence of the damage of lymphatic vessels. In our country, it is more frequently related to the surgical treatment of cancer. The incidence varies depending on the type of cancer and the treatment received, with an increased risk in cases in which lymphadenectomy and radiotherapy are performed. Clinical diagnosis and imaging techniques are essential to asses the functional status of the lymphatic system. The main objectives in the management of lymphedema are to limit patient morbidity, improve functionality and quality of life. There are procedures that seek to prevent the development of lower extremity lymphedema. Once established, the treatment can be conservative and surgical. Surgical treatment includes physiological (reconstructive) and excisional procedures. Success depends on a good selection of patients and the performance of an individualized treatment. The following is a review regarding the incidence, risk factors, diagnostic strategies and surgical techniques with emphasis on microsurgical treatment.

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Section: Tratamiento Conservadorunclassified

Linfedema de extremidades inferiores secundario al tratamiento oncológico: actualización en el diagnóstico y tratamiento quirúrgico

Pereira

Yamamoto

2019

Rev. cir.

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“…1,2 Complete decongestive therapy (CDT) is the standard treatment for lymphedema of the extremities. 3,4 If CDT is not effective, then surgical treatment, including lymphaticovenous anastomosis, lymph node transfer, or liposuction, may be performed. [5][6][7][8][9] CDT includes compression therapy, manual lymph drainage, skin care, and exercise.…”

Section: Introductionmentioning

confidence: 99%

Compression Pressure Variability in Upper Limb Multilayer Bandaging Applied by Lymphedema Therapists

Hara

Yoshida²,

Ikehata³

et al. 2021

Lymphatic Research and Biology

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Background: Multilayer bandaging (MLB) is often used for lymphedema treatment. Even experienced lymphedema therapists have difficulty applying bandages correctly. The aim of this study was to demonstrate upper limb MLB pressure variability applied by lymphedema therapists. Methods and Results: Twenty-four lymphedema therapists were asked to apply MLB to the healthy volunteer's upper limb. The participants consisted of 20 females and 4 males with a mean age of 43.4 (range: 24-62) years. They included licensed massage therapists, nurses, a judo therapist, an occupational therapist, and a medical doctor. Twenty therapists (83.3%) had clinical experience applying MLB. Compression pressure was measured with PicoPress at 5 cm proximal to the wrist, immediately after the application (phase 1) and after exercise (phase 2). The mean MLB pressure was 67.7 -5.0 mmHg in phase 1 and 55.3 -4.1 mmHg in phase 2, which were significantly different ( p = 1.2 • 10 -10 ). There was a weak negative correlation between how long the therapist had been practicing MLB and MLB pressure (R = 0.29). Seventeen participants (70.8%) expressed that they had a target pressure in mind when performing MLB. Among the 17 participants, there was no correlation between the target and actual pressures (R = -0.055). Only three participants (17.6%) had an actual MLB pressure within 5 mmHg of their target. Conclusions: The mean MLB pressure was 55.3 -4.1 mmHg, which was thought to be too high for the upper limb. Education about applying appropriate MLB pressures to the limbs is necessary.

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“…Lymphedema is a disease in which lymphatic fluid accumulates in the skin or subcutaneous tissue. The standard treatment for lymphedema is complex decongestive therapy, including manual lymph drainage, compression therapy, skin care, and exercises performed while wearing compression garments (Ezzo et al, ; Iwersen, Sperandio, Toriy, Palú, & Medeiros da Luz, ; Lasinski, ). For cases that are refractory to complex decongestive therapy, surgery is sometimes performed.…”

Section: Introductionmentioning

confidence: 99%

Multi‐area lymphaticovenous anastomosis with multi‐lymphosome injection in indocyanine green lymphography: A prospective study

Hara

Mihara

2018

Microsurgery

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Background Detecting more number of functional lymphatic vessels is the essential point in lymphaticovenous anastomosis (LVA). The purpose of this prospective study was to elucidate the efficacy of multi‐area injection in indocyanine green (ICG) lymphography in LVA. Methods We injected ICG into the first web spaces of the feet or the second web space of the hands, subcutaneously. In multi‐area injection group, we injected additional ICG in other areas. We determined the incision design of LVA on the line at about 5 cm distal to dermal backflow point. In control group, we determined the incision site based on the linear pattern in ICG lymphography and lymphoscintigraphic findings. We performed LVA, and evaluated the circumference change and the intraoperative condition of the collecting lymphatic vessels based on Normal, Ectasis, Contraction, and Sclerosis Type (NECST) classification. Results Sixty patients (115 limbs) in multi‐injection group and 49 patients (81 limbs) in control group were included. We injected ICG into an average of 1.9 sites in multi‐injection group. The average number of anastomoses per limb was 3.3 in both groups. The average circumference change was −1.83% in multi‐injection group and −0.34% in control group (P = .021). The percentage of the Ectasis type lymphatic vessels was 59.0% in multi‐injection group and 40.2% in control group (P = 3.30 × 10−5). Conclusions By injecting ICG into multiple sites in the affected limbs, we could detect a greater number of functional lymphatic vessels (Ectasis type) during LVA. This could lead to a better surgical result.

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

Cited by 24 publications

References 31 publications

Linfedema de extremidades inferiores secundario al tratamiento oncológico: actualización en el diagnóstico y tratamiento quirúrgico

Linfedema de extremidades inferiores secundario al tratamiento oncológico: actualización en el diagnóstico y tratamiento quirúrgico

Compression Pressure Variability in Upper Limb Multilayer Bandaging Applied by Lymphedema Therapists

Multi‐area lymphaticovenous anastomosis with multi‐lymphosome injection in indocyanine green lymphography: A prospective study

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