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Mayrovitz HN. Intra-day variations in volar forearm skin hydration. Skin Res Technol 2024; 30:e13849. [PMID: 38978227 PMCID: PMC11231035 DOI: 10.1111/srt.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Skin hydration (SKH) measurements are used for multiple purposes: to study skin physiology, to clinically investigate dermatological issues, and to assess localized skin water in pathologies like diabetes and lymphedema. Often the volar forearm is measured at various times of day (TOD). This report aims to characterize intra-day variations in volar forearm SKH to provide guidance on expected TOD dependence. MATERIALS AND METHODS Forty medical students (20 male) self-measured tissue dielectric constant (TDC) on their non-dominant forearm in triplicate as an index of local skin tissue water every 2 h starting at 0800 and ending at 2400 h. All were trained and pre-certified in the procedure and had whole-body fat (FAT%) and water (H2O%) measured. Day average TDC (TDCAVG) was determined as the average of all time points expressed as mean ± SD. RESULTS Males versus females had similar ages (25.1 ± 2.2 years vs. 25.1 ± 1.5 years), higher H2O% (56.6 ± 5.0 vs. 51.8 ± 5.7, p = 0.002), and higher TDCAVG (32.7 ± 4.1 vs. 28.5 ± 5.1, p = 0.008). TDC values were not significantly impacted by H2O% or FAT%. Female TDC exhibited a significant decreasing trend from morning to night (p = 0.004); male TDC showed no trend. CONCLUSION Skin water assessed by TDC shows some intra-day variations for females and males but with quite different temporal patterns. Clinical relevance relates to the confidence level associated with skin hydration estimates when measured at different times of day during normal clinic hours which, based on the present data, is expected to be around 5% for both males and females.
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Affiliation(s)
- Harvey N. Mayrovitz
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic MedicineNova Southeastern UniversityFort LauderdaleUSA
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Devoogdt N, De Vrieze T, Heroes AK, Bechter-Hugl B, Fieuws S, Godderis L, Segers K, Maleux G, Deltombe T, Frippiat J, Servaes M, Berners A, Fosseprez P, Krug B, Kayser F, Falticeanu A, Randon C, Monten C, Van Landuyt K, De Pypere B, Degraeve L, Decorte T, De Schryver M, Van Besien V, Devos D, Suominen S, Ayala JM, Pons G, Fourneau I, Thomis S. SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema. BMJ Open 2024; 14:e078114. [PMID: 38729754 PMCID: PMC11145716 DOI: 10.1136/bmjopen-2023-078114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Lymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and physical problems limiting quality of life. The first choice of treatment is a conservative treatment, consisting of exercises, skin care, lymph drainage and compression. Reconstructive lymphatic surgery is also often performed, that is, lymphovenous anastomoses, lymph node transfer or a combination. However, robust evidence on the effectiveness of reconstructive lymphatic surgery is missing. Therefore, the objective of this trial is to investigate the added value of reconstructive lymphatic surgery to the conservative treatment in patients with lymphoedema. METHODS AND ANALYSIS A multicentre randomised controlled and pragmatic trial was started in March 2022 in three Belgian university hospitals. 90 patients with arm lymphoedema and 90 patients with leg lymphoedema will be included. All patients are randomised between conservative treatment alone (control group) or conservative treatment with reconstructive lymphatic surgery (intervention group). Assessments are performed at baseline and at 1, 3, 6, 12, 18, 24 and 36 months. The primary outcome is lymphoedema-specific quality of life at 18 months. Key secondary outcomes are limb volume and duration of wearing the compression garment at 18 months. The approach of reconstructive lymphatic surgery is based on presurgical investigations including clinical examination, lymphofluoroscopy, lymphoscintigraphy, lymph MRI or CT angiography (if needed). All patients receive conservative treatment during 36 months, which is applied by the patient's own physical therapist and by the patient self. From months 7 to 12, the hours a day of wearing the compression garment are gradually decreased. ETHICS AND DISSEMINATION The study has been approved by the ethical committees of University Hospitals Leuven, Ghent University Hospital and CHU UCL Namur. Results will be disseminated via peer-reviewed journals and presentations. TRIAL REGISTRATION NUMBER NCT05064176.
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Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - An-Kathleen Heroes
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Beate Bechter-Hugl
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven - University of Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katarina Segers
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, Centre de Reference du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Jacqueline Frippiat
- Department of Physical Medicine and Rehabilitation, Centre de Reference du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Maxime Servaes
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Aline Berners
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Philippe Fosseprez
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Bruno Krug
- Nuclear Medicine Department, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Francoise Kayser
- Department of Radiology, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Ana Falticeanu
- Department of Radiology, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Chris Monten
- Department of Radiotherapy, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Koen Van Landuyt
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Bernard De Pypere
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Liesl Degraeve
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Tina Decorte
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Mieke De Schryver
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Vickie Van Besien
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Daniel Devos
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jaume Masia Ayala
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau and the Hospital del Mar of Barcelona, Barcelona, Spain
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau and the Hospital del Mar of Barcelona, Barcelona, Spain
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
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Toro C, Markarian B, Mayrovitz HN. Breast Cancer-Related Lymphedema Assessed via Tissue Dielectric Constant Measurements. Cureus 2024; 16:e59261. [PMID: 38813316 PMCID: PMC11135004 DOI: 10.7759/cureus.59261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
This review describes the use of tissue dielectric constant (TDC) measurements mainly in the assessment of breast cancer-related lymphedema (BCRL). PubMed, Web of Science, and EMBASE databases were initially searched using criteria that included the terms "dielectric" and "lymphedema." The initial search yielded a total of 131 titles. After removing studies not focused on upper extremity lymphedema, 56 articles remained. These articles, together with relevant articles from their bibliographies, formed the basis of the review. The findings show the potential utility and applications of TDC measurements to help detect and track BCRL, whether present in limbs, breasts, or trunks. It is reported as a non-invasive, simple-to-use method, with each measurement requiring less than 10 seconds, suggesting its practicality and useability as an in-office or in-clinic screening and tracking method. Although there are various ways to quantitatively evaluate lymphedema, most, if not all, are restricted to measurements on limbs. Thus, one significant advantage of the TDC approach is that almost any local region of interest can be effectively measured and tracked, which, for BCRL, could include specific regions of arms or hands, breasts, and truncal areas.
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Affiliation(s)
- Carel Toro
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Biura Markarian
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Arends CR, van der Molen L, van den Brekel MWM, Stuiver MM. Test-Retest Reliability of a Protocol for Assessment of Local Tissue Water in the Head and Neck Area. Lymphat Res Biol 2024; 22:12-19. [PMID: 37815799 DOI: 10.1089/lrb.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Background: Lymphedema measurement is vital to select appropriate treatment and monitor its progress. Quantifying lymphedema in the head and neck area is challenging. The use of tissue dielectric constant (TDC) measurements has shown promising results in other body areas. This study aims to determine the test-retest reliability of a TDC measurement protocol developed for the head and neck area. Methods and Results: A detailed measurement protocol, including eight measurement points per side, was developed. Subsequently, the reliability of the protocol was tested in a sample of healthy participants (n = 50, 28 males). Using the LymphScanner (Delfin, Finland), participants were subjected to two measurement sessions. Each measurement point was measured three times per session. Test-retest reliability for each point was evaluated using intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs). Using the average of three measurements, reliability was good to excellent for all points (ICCs 0.81-0.95), with small measurement errors (SEMs 1.51-2.86). The reliability of a single measurement was moderate to excellent for all measurement points (ICCs 0.58-0.87), with larger, but still small, measurement errors (SEMs 1.65-3.39). When using single measurements, the lowest ICCs were found for the temporal (left 0.73 and right 0.67) and submandibular (left 0.58 and right 0.77) locations. Conclusion: Measurements with the LymphScanner, taken according to the developed protocol, are reliable in healthy participants. We recommend using the average of three measurements to optimize reliability. The protocol is fit for further testing in patient populations and for determining normal values in a larger scale study with healthy subjects.
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Affiliation(s)
- Coralie R Arends
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication, ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication, ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department for Quality of Life, Division of Psychosocial Oncology and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Fearn N, Llanos C, Dylke E, Stuart K, Kilbreath S. Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review. J Cancer Surviv 2023; 17:1669-1687. [PMID: 36301407 PMCID: PMC10539190 DOI: 10.1007/s11764-022-01278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures. METHOD Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence. RESULTS Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast). CONCLUSIONS Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures. IMPLICATIONS FOR CANCER SURVIVORS There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.
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Affiliation(s)
- Nicola Fearn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia
| | - Catalina Llanos
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Elizabeth Dylke
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia
| | - Kirsty Stuart
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Sharon Kilbreath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia.
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Mayrovitz HN. Medical Applications of Skin Tissue Dielectric Constant Measurements. Cureus 2023; 15:e50531. [PMID: 38222165 PMCID: PMC10787628 DOI: 10.7759/cureus.50531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Tissue dielectric constant (TDC) values assess certain skin properties that are dependent on multiple factors but mainly on the relative amount of water content within a locally measured tissue volume. Because of the non-invasive nature of these measurements and their ease of use, the method has been widely used in various medically related applications. The goal of this paper was to review and describe the uses and findings of such TDC measurements, considering and including the wide array of medical applications. The review is in part based on information derived from an analysis of published material obtained via literature searches of four major electronic databases and, in part, based on the author's experience with the TDC measurement methods and their various applications and his professional experiences. The databases searched were PubMed, Web of Science, EMBASE, and CINAHL Complete. Based on the initial search criteria, a total of 1257 titles were identified. After removing duplicates and filtering according to relevancy, 160 remained for detailed further review. In some cases, the bibliography of these retrieved articles provided additional sources. The findings demonstrate multiple research and medical uses and applications of TDC measurements, focusing on detecting and quantifying localized edema and lymphedema in multiple target sites. These include the upper and lower extremities, breasts, and trunk as regions involved in medical conditions causing lymphedema. In addition, the findings suggest that TDC evaluations are a convenient, non-invasive method to study and evaluate other conditions impacting skin, including diabetes mellitus and skin wounds or ulcers. Its ability to detect aspects of tissue changes simply and rapidly at almost any anatomical location makes it a useful tool for investigating multiple dermatological conditions and their treatment as future applications of this method.
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Affiliation(s)
- Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Mayrovitz HN, Shams E, Astudillo A, Jain A. Tissue Dielectric Constant and Skin Stiffness Relationships in Lower Extremity Lymphedema. Lymphat Res Biol 2023; 21:439-446. [PMID: 37172282 DOI: 10.1089/lrb.2022.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Background: Lower extremity lymphedema or edema (LELE) may progressively transition from a state of excess tissue fluid to increased fat accumulation and collagen deposition, with tissue fibrosis and hardening. Such changes may lead to altered tissue water holding and thereby impact tissue dielectric constant (TDC). This study seeks to evaluate the relationship between TDC and tissue indentation force (TIF) in patients with LELE and assess the utility of the leg/arm TDC ratio (LAR) as an indicator of LELE. Methods and Results: Thirty females (49-91 years) with previously diagnosed LELE were evaluated during a scheduled session. TDC and TIF were measured 8 cm proximal to the medial malleolus on the medial and lateral aspects of both legs and on one forearm 8 cm distal to the antecubital fossa. The TDC-TIC relationship and the LAR were subsequently determined. Main results showed an absence of a significant correlation between TDC and TIF on medial or lateral leg sites but a positive correlation on the normal forearm site. Further, LAR values exceeded the published proposed threshold of 1.35 for 29/30 patients when using medial-side TDC values and 28/30 patients when using lateral-side TDC values. Conclusions: Findings suggest that for patients with LELE, TDC values are significantly elevated on medial and lateral standardized sites. The LAR determined using either medial or lateral sites that are similar to each other and have values consistent with a lymphedema threshold of 1.35. In edematous legs of the type evaluated herein, there is no apparent relationship between TDC values and indentation force.
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Affiliation(s)
- Harvey N Mayrovitz
- Division of Physiology, Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Elham Shams
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Andrea Astudillo
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Aakangsha Jain
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida, USA
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Ehmann S, Mayrovitz HN. Variation in Leg Tissue Dielectric Constant Values of Healthy Young Adult Females With and Without Compression Bandaging. Cureus 2023; 15:e38647. [PMID: 37292526 PMCID: PMC10245081 DOI: 10.7759/cureus.38647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin in a specific location. The goals of the present research were (1) to characterize TDC values, expressed as percentage tissue water, from multiple areas along the medial aspect of the lower leg of healthy volunteers and (2) to explore the potential utilization of the TDC values to assess change in tissue water content in a localized area following compression applications. Methods TDC was measured at 10, 20, 30, and 40 cm proximal to the medial malleolus on the medial aspect of the right leg of 18 young adult healthy women with an age range of 18-23 years and a body mass index of 18.7 to 30.7kg/m2.. TDC was measured at baseline and after 10 minutes of exercise with compression in place on three separate days during which three different compression applications were assessed: a longitudinal elastic stockinette, a two-layer cohesive compression kit, and a combination of the two. Leg circumferences and compression-related interface pressures were also measured. Results Test-Retest Reliability of circumferential measurements and TDC values evaluated using Intraclass correlation coefficient (ICC 3,1) revealed excellent and moderate-to-good reliability, respectively. Analysis of TDC values along the length of the limb using Friedman's test, revealed a small but statistically significant overall difference among baseline TDC values attributable to a smaller value at 40 cm. The largest difference in cumulative average was 7.7% which occurred between 20 and 40 cm, with all other differences between locations less than 1%. No significant differences between the compression applications were observed. Conclusion The present findings demonstrate the utility of TDC measurements as a modality to assess compression-related changes in the legs of healthy women as a foundation for their potential use in assessing outcomes of compression treatments for persons with lower extremity edema or lymphedema. The absence of a significant change in TDC values in these healthy non-edematous conditions and the demonstrated reliability of the TDC measurements on three different days provides further support for the utility of such applications of TDC measurements. The extension to patients with lower extremity edema or lymphedema needs to be evaluated.
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Affiliation(s)
- Suzie Ehmann
- Physical Therapy, Nova Southeastern University, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Thomis S, Devoogdt N, Bechter-Hugl B, Fourneau I. Early Disturbance of Lymphatic Transport as a Risk Factor for the Development of Breast-Cancer-Related Lymphedema. Cancers (Basel) 2023; 15:cancers15061774. [PMID: 36980660 PMCID: PMC10046360 DOI: 10.3390/cancers15061774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Breast-cancer-related lymphedema (BCRL) is a frequently occurring and debilitating condition. When lymphedema is diagnosed late, treatment can be expected to be less effective. Lymphofluoroscopy can provide details about the superficial lymphatic architecture and can detect an early disturbance of lymphatic transport (i.e., dermal backflow) before the lymphedema is clinically visible. The main objective of this study is to investigate whether this early disturbance of lymphatic transport visualized by lymphofluoroscopy is a risk factor for the development of BCRL. Methodology: All patients scheduled for unilateral breast cancer surgery with axillary lymph node dissection or sentinel node biopsy were considered. Patients were assessed at baseline and 1, 3, 6, 9, 12, 18, 24 and 36 months postoperatively. During each visit, a clinical assessment was performed to determine the volume difference between both arms and hands (through circumference measurements and water displacement). Clinical BCRL was defined as a ≥5% increase in relative arm volume difference compared to the baseline value. Variables related to (1) the disturbance of lymphatic transport (through lymphofluoroscopy), (2) the demographics and general health of the patient and (3) the breast cancer and treatment of the patient were collected. Results: We included data of 118 patients in the present study. Thirty-eight patients (39.8%) developed BCRL. Early disturbance of lymphatic transport was identified as a risk factor for the development of clinical BCRL (HR 2.808). Breast-cancer- and treatment-related variables such as axillary lymph node dissection (ALND) (HR 15.127), tumor stage (HR 1.745), mastectomy (HR 0.186), number of positive lymph nodes (HR 1.121), number of removed lymph nodes (HR 1.055), radiotherapy of the axilla (HR 2.715), adjuvant taxanes (HR 3.220) and postsurgical complications (HR 2.590) were identified as significant risk factors for the development of BCRL. In the multivariate analysis, age and ALND were withheld as independent risk factors for the development of BCRL. Conclusion: Lymphofluoroscopy can identify an early disturbance of lymphatic transport after breast cancer treatment. Patients with an early disturbance of lymphatic transport are considered to be a high-risk group for the development of BCRL. This study also confirms that age and ALND are predictors for the development of BCRL. Therefore, a surveillance program of these patients with lymphofluoroscopy could be useful to identify lymphedema in subclinical stages.
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Affiliation(s)
- Sarah Thomis
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16346850
| | - Nele Devoogdt
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Beate Bechter-Hugl
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Inge Fourneau
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
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De Vrieze T, Gebruers N, Nevelsteen I, Thomis S, De Groef A, Tjalma WAA, Belgrado JP, Vandermeeren L, Monten C, Hanssens M, Asnong A, Dams L, Van der Gucht E, Heroes AK, Devoogdt N. Does Manual Lymphatic Drainage Add Value in Reducing Suprafascial Fluid Accumulation and Skin Elasticity in Patients With Breast Cancer-Related Lymphedema? Phys Ther 2022; 102:pzac137. [PMID: 36209432 DOI: 10.1093/ptj/pzac137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/31/2022] [Accepted: 07/10/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) versus that of traditional and placebo MLD, when added to decongestive lymphatic therapy (DLT) for the treatment of breast cancer-related lymphedema (BCRL) (EFforT-BCRL trial), on the suprafascial accumulation of lymphatic fluid and skin elasticity. METHODS In this multicenter, 3-arm, double-blind, randomized controlled trial (EFforT-BCRL trial), 194 participants (mean age = 61 [SD = 10] years) with unilateral BCRL were recruited. All participants received standardized DLT (education, skin care, compression therapy, exercises) and were randomized to fluoroscopy-guided, traditional, or placebo MLD. Participants received 60 min/d of treatment during the 3-week intensive phase and 18 sessions of 30 minutes during the 6-month maintenance phase. During this phase, participants were instructed to wear a compression garment, to perform exercises, and to perform a self-MLD procedure once daily. This study comprises secondary analyses of the EFforT-BCRL trial. Outcomes were the amount of fluid accumulation in the suprafascial tissues (local tissue water, extracellular fluid, and thickness of the skin and subcutaneous tissue) and skin elasticity at the level of the arm and trunk. Measurements were performed at baseline; after intensive treatment; after 1, 3, and 6 months of maintenance treatment; and after 6 months of follow-up. RESULTS At the level of the arm, there was a significant improvement over time in the 3 groups for most of the outcomes. At the level of the trunk, no remarkable improvement was noted within the individual groups. No significant interaction effects (between-group differences) were present. Only skin elasticity at the level of the arm, evaluated through palpation, showed a significant interaction effect. CONCLUSION All 3 groups showed similar improvements in response to DLT regardless of the type of MLD that was added. The effect of the addition of MLD to other components of DLT for reducing local tissue water and extracellular fluid or skin thickness and for improving skin elasticity and fibrosis in participants with chronic BCRL was limited. IMPACT Although MLD has been applied all over the world for many years, evidence regarding its added value in reducing arm volume in patients with BCRL is lacking. These results show that adding MLD to other components of DLT has limited value in reducing local tissue water and extracellular fluid or skin thickness and in improving skin elasticity and fibrosis in patients with chronic BCRL. To date, there is no clinical indication to continue including time-consuming MLD in physical therapist sessions for patients with chronic BCRL.
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Affiliation(s)
- Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Nick Gebruers
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
| | - Ines Nevelsteen
- UZ Leuven - University Hospitals Leuven, Multidisciplinary Breast Centre, Leuven, Belgium
| | - Sarah Thomis
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
| | - An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Wiebren A A Tjalma
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
- University of Antwerp, Department of Medicine, MIPRO, Antwerp, Belgium
- Antwerp University Hospital, Multidisciplinary Breast Clinic, Antwerp, Belgium
| | - Jean-Paul Belgrado
- Université Libre de Bruxelles, Lymphology Research Unit, Brussels, Belgium
| | | | - Chris Monten
- Ghent University Hospital, Department of Radiotherapy, Ghent, Belgium
| | - Marianne Hanssens
- General Hospital Groeninge, Department of Oncology, Centre for Oncology, Kortrijk, Belgium
| | - Anne Asnong
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Lore Dams
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Elien Van der Gucht
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - An-Kathleen Heroes
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
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11
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Dylke E. Measurement of breast cancer-related lymphoedema. J Physiother 2022; 68:238-243. [PMID: 36244958 DOI: 10.1016/j.jphys.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Elizabeth Dylke
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.
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12
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Ricci V, Ricci C, Gervasoni F, Giulio C, Farì G, Andreoli A, Özçakar L. From physical to ultrasound examination in lymphedema: a novel dynamic approach. J Ultrasound 2022; 25:757-763. [PMID: 35000129 PMCID: PMC9402863 DOI: 10.1007/s40477-021-00633-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
In daily practice, medical history and physical examination are commonly coupled with anthropometric measurements for the diagnosis and management of patients with lymphatic diseases. Herein, considering the current progress of ultrasound imaging in accurately assessing the superficial soft tissues of the human body; it is noteworthy that ultrasound examination has the potential to augment the diagnostic process. In this sense/report, briefly revisiting the most common clinical maneuvers described in the pertinent literature, the authors try to match them with possible (static and dynamic) sonographic assessment techniques to exemplify/propose an 'ultrasound-guided' physical examination for different tissues in the evaluation of lymphedema.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fabrizio Gervasoni
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cocco Giulio
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Giacomo Farì
- Section of Physical Medicine and Rehabilitation, Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Arnaldo Andreoli
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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13
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Mayrovitz HN. Measuring Breast Cancer-Related Lymphedema. Breast Cancer 2022. [DOI: 10.36255/exon-publications-breast-cancer-lymphedema] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Mayrovitz HN. Circumferential and Depth Variations in Tissue Dielectric Constant Values as Indices of Lower Leg Localized Skin Water. Cureus 2022; 14:e27617. [PMID: 36059342 PMCID: PMC9433792 DOI: 10.7759/cureus.27617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022] Open
Abstract
The primary goal of this study was to quantify circumferential (medial, anterior, lateral) and measurement depth variations (0.5 mm, 1.5 mm, 2.5 mm) in tissue dielectric constant (TDC) values as an aid to their use to assess the presence and progression of lower extremity edema and lymphedema. Measurements were done in 30 healthy non-edematous women to provide reference data to estimate expected values and thresholds when evaluating clinical edematous or lymphedematous conditions. A second goal was to determine the extent to which TDC values evaluated at lower leg sites depend on body mass index (BMI). The study protocol (#12180901) was approved by the university’s institutional review board and subjects were evaluated after signing an approved informed consent. The study group had an age range of 19-54 years with a mean age and SD of 30.6 ± 10.1 years and had a BMI between 18.1-44.1 Kg/m2 with a mean BMI and SD of 24.5 ± 5.4 Kg/m2. The main findings show that at the three circumferential sites (medial, anterior, and lateral) located eight cm from the mid-malleolus, there are small but statistically significant differences in TDC values at every measurement depth (0.5 mm, 1.5 mm and 2.5 mm). For each depth, the maximum difference occurs between the medial and lateral locations with lateral locations having a greater TDC value at all depths. Despite the wide range of BMI values of the subjects evaluated, no significant relationship between TDC value and BMI was detected. It is concluded that TDC measurements in the lower leg reveal statistically significant differences among circumferential sites and measurement depths that should be considered when evaluating or tracking lower extremity tissue water changes associated with edema, lymphedema or other conditions related to skin water. The absolute values of these non-edematous TDC values herein determined may provide a basis for calculating TDC thresholds applicable to edematous or lymphedematous lower leg conditions.
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15
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Mayrovitz HN. Tissue Dielectric Constant of the Lower Leg as an Index of Skin Water: Temporal Variations. Cureus 2022; 14:e26506. [PMID: 35923478 PMCID: PMC9339369 DOI: 10.7759/cureus.26506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Tissue dielectric constant (TDC) measurements are a convenient, reliable, and accurate way to noninvasively access local tissue water content and its change with time or treatment. The method has been widely used for upper extremity lymphedema assessments but less so for lower extremities. For lower extremity assessments, it would be useful to have an estimate of the expected inter-leg TDC differentials of normal non-affected legs to help interpret measured inter-leg differentials when such measurements are done in patients with lower extremity edema or lymphedema. The goals of this study were to determine normal inter-leg TDC differences, quantify TDC temporal changes during 60 minutes of supine lying in a group of 10 middle-aged women (42-57 years), and evaluate the change in TDC values as measured throughout the day from 0800 to 2000 hours in a group of 10 younger women (23-28 years). The overall findings indicate that TDC measurements, as an assessment parameter of lower extremity localized skin-to-fat tissue water, are only minimally dependent on potential confounding factors such as 60-minute supine lying or the time of day at which the measurements are made. If the small sample size of the present study is reflective of the larger population, an inter-leg TDC ratio exceeding a value of 1.2 is suggested as a threshold for judging unilateral lower extremity edema or lymphedema. This possibility needs assessment in women with these conditions.
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16
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Karlsson K, Johansson K, Nilsson-Wikmar L, Brogårdh C. Tissue Dielectric Constant and Water Displacement Method Can Detect Changes of Mild Breast Cancer-Related Arm Lymphedema. Lymphat Res Biol 2021; 20:325-334. [PMID: 34551275 DOI: 10.1089/lrb.2021.0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Most commonly, volume measurements are used to evaluate the effect of lymphedema treatment, but as the accumulation of lymph fluid can be local, this method may not always be the best. Tissue dielectric constant (TDC) can be applied to identify local lymphedema changes, but has not been used before when evaluating treatment in mild arm lymphedema. Thus, the overall aim of this study was to examine if TDC and water displacement method (WDM) can measure changes in mild breast cancer-related lymphedema during the 6-month standard treatment. More specifically, we examined changes within and between three defined groups based on lymphedema thresholds of TDC and WDM at start of treatment, as well as changes of the highest TDC ratio and site. Methods and Results: Forty-six women with mild arm lymphedema, received treatment with compression sleeves, mostly ccl 1, and instructions about self-care. Local tissue water was measured by TDC at six defined sites and lymphedema relative volume (LRV) by WDM before treatment and at first, second, third, and sixth month. There was a significant decrease in the site with the highest TDC ratio, as well as LRV at all follow-up visits. At 6 months, TDC ratio had decreased mean 0.26 (p < 0.001) and LRV mean - 3.3% (p < 0.001). There was a significant difference between the groups in change of TDC ratio, but not in LRV. Sixty percent changed the overall highest TDC ratio to another site during 6 months. Conclusion: Both TDC and WDM could detect changes in mild arm lymphedema but should be interpreted separately.
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Affiliation(s)
- Katarina Karlsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Physiotherapy Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
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17
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Tallroth L, Brorson H, Mobargha N, Velander P, Klasson S, Becker M. Assessment of local tissue water in breasts following breast reconstruction with an expander prosthesis or DIEP flap. J Plast Surg Hand Surg 2021; 56:217-223. [PMID: 34342547 DOI: 10.1080/2000656x.2021.1956504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investigate local tissue water (LTW) and breast oedema-related symptoms in breasts reconstructed with either an expander prosthesis (EP) or with a deep inferior epigastric perforator (DIEP) flap at a minimum of one year postoperatively. Sixty-eight patients randomised to breast reconstruction with an EP or DIEP flap completed follow-up. Objective evaluation was performed at a mean of 25 (standard deviation, SD 9.5) months following breast reconstruction, and included measurements of breast volume and LTW with the MoistureMeterD® instrument. The patients completed the BREAST-Q questionnaire pre- and postoperatively. No significant differences in LTW were found when comparing EP and DIEP flap reconstructed breasts. The reconstructed breasts had an increase in LTW compared with the non-operated contralateral breasts. The BREAST-Q responses related to breast oedema symptoms were overall low and the median responses ranged from 1 to 2. A score of 1 indicated that symptoms were experienced 'None of the time'. Our findings indicate that mastectomy followed by breast reconstruction inflicts damage on the lymphatic system, shown as an increase in LTW. However, no breast oedema-related symptoms were reported in the BREAST-Q questionnaire, and therefore, we consider our objective results to be below a potential threshold for symptomatic breast oedema. A threshold for clinical indication of breast oedema remains to be defined.
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Affiliation(s)
- Linda Tallroth
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Håkan Brorson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Nathalie Mobargha
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Patrik Velander
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stina Klasson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Becker
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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18
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Jørgensen MG, Hermann AP, Madsen AR, Christensen S, Ingwersen KG, Thomsen JB, Sørensen JA. Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition. Cancers (Basel) 2021; 13:cancers13143584. [PMID: 34298799 PMCID: PMC8303539 DOI: 10.3390/cancers13143584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Cellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL); however, it is not known whether cellulitis is associated with the severity and biocompositon of BCRL. This study showed that cellulitis was associated with more excess volume, fat, and lean arm mass. Treatments should aim to prevent cellulitis in BCRL to possibly avoid the condition exacerbating. Abstract Cellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL). The excess amount of fat and lean mass in BCRL is a vital factor in patient stratification, prognosis, and treatments. However, it is not known whether cellulitis is associated with the excess fat and lean mass in BCRL. Therefore, this prospective observational study was designed to fundamentally understand the heterogonous biocomposition of BCRL. For this study, we consecutively enrolled 206 patients with unilateral BCRL between January 2019 and February 2020. All patients underwent Dual-Energy X-Ray Absorptiometry scans, bioimpedance spectroscopy, indocyanine green lymphangiography comprehensive history of potential risk factors, and a clinical exam. Multivariate linear and beta regression models were used to determine the strength of association and margins effect. Sixty-nine patients (33%) had at least one previous episode of cellulitis. Notably, a previous episode of cellulitis was associated with 20 percentage points more excess fat and 10 percentage points more excess lean mass compared to patients without cellulitis (p < 0.05). Moreover, each 1 increase in the patients BMI was associated with a 0.03 unit increase in the fat mass proportion of the lymphedema arm. Cellulitis was associated with more excess fat and lean arm mass in BCRL. In addition, patients BMI affect the proportion of fat mass in the arm.
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Affiliation(s)
- Mads Gustaf Jørgensen
- Department of Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark; (J.B.T.); (J.A.S.)
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Correspondence: ; Tel.: +45-2921-0114
| | - Anne Pernille Hermann
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark; (A.P.H.); (A.R.M.); (S.C.)
| | - Anette Riis Madsen
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark; (A.P.H.); (A.R.M.); (S.C.)
| | - Steffanie Christensen
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark; (A.P.H.); (A.R.M.); (S.C.)
| | - Kim Gordon Ingwersen
- Research Unit in Physiotherapy and Occupational Therapy, University Hospital of Sourthen Denmark—Vejle Hospital, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark; (J.B.T.); (J.A.S.)
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark; (J.B.T.); (J.A.S.)
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
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19
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Physical activity level and age contribute to functioning problems in patients with breast cancer-related lymphedema: a multicentre cross-sectional study. Support Care Cancer 2020; 28:5717-5731. [PMID: 32193692 DOI: 10.1007/s00520-020-05375-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/20/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Breast cancer survivors face a high risk of developing breast cancer-related lymphedema (BCRL). Besides physical symptoms such as swelling, BCRL can have a psychosocial impact and lead to problems in daily functioning. Understanding contributing variables to problems in functioning yields possibilities to improve treatment modalities and consequently patients' quality of life. Therefore, the aim of this study was to explore the association between patient-, lymphedema-, and cancer treatment-related variables with problems in functioning in patients with BCRL. METHODS A cross-sectional study was performed in 185 patients with BCRL. Problems in daily functioning (dependent variable) were evaluated with the Lymph-ICF-UL questionnaire. Following independent variables were analysed by bi-variate and multivariable analyses, including a stepwise regression analysis: patient-related variables (age, BMI, physical activity level, education), lymphedema-related variables (excessive arm volume, duration of lymphedema, total pitting score, presence of hand edema, hardness of the tissue, lymphedema stage), and cancer treatment-related variables (type of surgery, surgery at the dominant side, radiotherapy, chemotherapy, hormone therapy, immunotherapy, TNM-classification). RESULTS The Lymph-ICF-UL mean total score was 38% (± 21), representing a moderate amount of problems in general functioning. Multivariable regression analyses revealed that lower physical activity level and lower age are contributing factors to more problems in daily functioning. Stepwise regression analysis indicated that up to 8% of the variance in problems in functioning could be explained by physical activity level and age of patients with BCRL. CONCLUSION Especially patients with low physical activity level and younger patients experience more problems in functioning. For the determination of certain causal interactions, future longitudinal studies including other independent variables that might explain a higher amount of problems in functioning in this population, are warranted. TRIAL REGISTRATION The study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.
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Reza C, Nørregaard S, Moffatt C, Karlsmark T. Inter-observer and Intra-observer Variability in Volume Measurements of the Lower Extremity Using Perometer. Lymphat Res Biol 2020; 18:416-421. [PMID: 32159446 DOI: 10.1089/lrb.2019.0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The swelling of the extremities seen in lymphedema can be measured with many different volumetric devices; however, many methods lack important characteristics including reproducibility and independence from the subjectivity and skill of the operator. The aim of this study was to validate the use of the Perometer® as a possible standard for volumetric measurement methods based on the inter-observer and intra-observer variability when using a standard method of Perometry®. Methods and Results: Volumetric measurements were performed on 10 healthy test subjects by 5 individuals (the observers) who had been instructed in the measurement techniques to be used. The inter-observer variability was assessed by having the five observers measure all the test subjects both in the morning and in the early afternoon. The intra-observer variability was examined by having each observer measure all the 10 test subjects 4 times in a row in the aforementioned time frames. A data set was created using the measurements, allowing for the assessment of other parameters including variation of volume between the right and left leg and daily variation in swelling. Statistical measurements were performed using the Statistical Package for the Social Sciences (SPSS), from which it was determined that there was no statistically significant inter-observer (p-value 0.997) and intra-observer variation (p-value 0.995) based on a significance level of >5%. Furthermore, it was observed that a statistically significant difference in volume occurred in the leg volume during the day. Conclusion: It was concluded that the use of the Perometer provides consistent measurements of volume independent of the observer and therefore appears to provide a candidate standard for volumetric measurements.
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Affiliation(s)
- Carni Reza
- Department of Dermato-Venerology, Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermato-Venerology, Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Christine Moffatt
- Department of Dermato-Venerology, Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venerology, Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
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