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Senger JLB, Kadle RL, Skoracki RJ. Current Concepts in the Management of Primary Lymphedema. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050894. [PMID: 37241126 DOI: 10.3390/medicina59050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Primary lymphedema is a heterogeneous group of conditions encompassing all lymphatic anomalies that result in lymphatic swelling. Primary lymphedema can be difficult to diagnose, and diagnosis is often delayed. As opposed to secondary lymphedema, primary lymphedema has an unpredictable disease course, often progressing more slowly. Primary lymphedema can be associated with various genetic syndromes or can be idiopathic. Diagnosis is often clinical, although imaging can be a helpful adjunct. The literature on treating primary lymphedema is limited, and treatment algorithms are largely based on practice patterns for secondary lymphedema. The mainstay of treatment focuses on complete decongestive therapy, including manual lymphatic drainage and compression therapy. For those who fail conservative treatment, surgical treatment can be an option. Microsurgical techniques have shown promise in primary lymphedema, with both lymphovenous bypass and vascularized lymph node transfers demonstrating improved clinical outcomes in a few studies.
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Affiliation(s)
- Jenna-Lynn B Senger
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Rohini L Kadle
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Roman J Skoracki
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
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2
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Chima C, George S, Murray B, Moore Z, Costello M. Health-related quality of life and assessment in patients with lower limb lymphoedema: a systematic review. J Wound Care 2022; 31:690-699. [PMID: 36001703 DOI: 10.12968/jowc.2022.31.8.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the impact of lower limb lymphoedema (LLL) on health-related quality of life (HRQoL), and to identify the methodologies used to assess HRQoL and their adherence to the World Health Organization (WHO)-recommended HRQoL dimensions. METHOD A systematic review was used following the PRISMA guidance. Studies were eligible if they assessed HRQoL in adult patients with LLL. The search was conducted between September 2019 and February 2020 using CINAHL, PubMed, Scopus, EMBASE and the Cochrane Library database. Data were placed onto a pre-developed data extraction table and analysed using a narrative synthesis. Evidence-based Librarianship (EBL) was used for quality appraisal. RESULTS A total of 18 studies were identified, among which 10 were cross-sectional and eight were longitudinal studies. Twelve HRQoL questionnaires were identified and the Lymphoedema Quality of Life tool (LYMQoL) was the most commonly used. All of the studies except one had an EBL validity score of ≥75%. Although LLL causes a considerable impairment in HRQoL, the findings varied across the studies. All the studies considered at least four of the six WHO recommended dimensions, with none considering the spirituality dimension. Furthermore, physical functioning and wellbeing were discovered to be the worst affected HRQoL dimensions. CONCLUSION LLL adversely affects physical function, wellbeing and thus the HRQoL. The LYMQoL is the most commonly used questionnaire; despite this, all elements of the WHO recommendations were not captured in the included studies. However, accurate information on HRQoL indicating the impact of the disease on survivors' lives and complete wellbeing is needed to inform evidence-based decision-making. Furthermore, having a universally accepted, disease-specific methodology will facilitate comparison and contrasting of HRQoL in patients with LLL. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Comfort Chima
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Sherly George
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Bridget Murray
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science.,Faculty of Science, Medicine and Health, University of Wollongong, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Lida Institute, Shanghai.,Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University.,Cardiff University, Wales
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3
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Dioun S, Chen L, Melamed A, Gockley A, St Clair CM, Hou JY, Khoury-Collado F, Hershman DL, Wright JD. Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer. BJOG 2022; 129:1591-1599. [PMID: 34962708 DOI: 10.1111/1471-0528.17085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the patterns and outcomes of sentinel lymph node (SLN) assessment in women with endometrial cancer. DESIGN Retrospective cohort study. SETTING United States inpatient and outpatient hospital services. POPULATION Women with endometrial cancer who underwent a laparoscopic or robotic-assisted hysterectomy. METHODS The Perspective Database from 2012 to 2018 was used. Performance of lymph node dissection was classified as SLN mapping, lymph node dissection or no nodal evaluation. Adjusted regression models were developed to examine the association between SLN mapping and morbidity and cost. MAIN OUTCOME MEASURES Utilisation rates, morbidity and cost of both lymph node dissection and SLN mapping. RESULTS Among 45 381 patients, SLN mapping was performed for 7768 patients (17.1%), lymph node dissection was performed for 23 214 patients (51.2%) and no lymphatic evaluation was performed for 14 399 patients (31.7%). SLN mapping increased from 1.8% in 2012 to 35.3% in 2018, whereas the rate of lymph node dissection decreased from 63.5% to 39.1% (p < 0.001). Among women who underwent nodal evaluation, residence in the west, White race and use of robotic-assisted hysterectomy were associated with SLN mapping (p < 0.05 for all). The complication rate was 5.9% for SLN mapping, compared with 7.3% in those that underwent lymph node dissection (aRR 0.85, 95% CI 0.77-0.95). The median hospital costs for women who underwent SLN mapping ($10 479) and lymph node dissection ($10 747) were higher than for those who did not undergo nodal assessment ($9149) (p < 0.001). CONCLUSIONS The performance of SLN mapping is increasing for endometrial cancer. Compared with lymph node dissection, SLN mapping is associated with lower morbidity. SLN mapping significantly increases the costs compared with hysterectomy alone. TWEETABLE ABSTRACT SLN mapping is increasing rapidly for endometrial cancer and is associated with decreased perioperative morbidity.
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Affiliation(s)
- Shayan Dioun
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Allison Gockley
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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Carretti G, Mirandola D, Maestrini F, Sequi L, Germano S, Muraca MG, Miccinesi G, Manetti M, Marini M. Quality of life improvement in breast cancer survivors affected by upper limb lymphedema through a novel multiperspective physical activity methodology: a monocentric pilot study. Breast Cancer 2022; 29:437-449. [PMID: 35025064 DOI: 10.1007/s12282-021-01322-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic lymphedema causes psychophysical sequelae jeopardizing quality of life (QoL) of breast cancer (BC) survivors, and lack of effective therapies represents a major challenge for healthcare professionals. Structured adapted physical activity (APA) may represent an effective strategy to attenuate cancer treatment-related impairments and improve QoL. Here, we describe the effects of a specific APA intervention based on a novel multiperspective methodology in counteracting lymphedema-related morphofunctional alterations and improving QoL of BC survivors. METHODS BC survivors with chronic moderate/severe lymphedema attending the Cancer Rehabilitation Center in Florence were assessed before and after 8-week APA. The protocol consisted of both APA specialist-supervised and self-leaded sessions using a tailor-designed proprioceptive board. Body mass index, bioimpedance parameters, indirect upper limb volume measurement, and ultrasonography were performed. Wrist flexion/extension and hand strength functional tests were also executed. QoL, depression/anxiety and pain intensity were evaluated by ULL27, HADS, distress thermometer and NRS questionnaires, respectively. RESULTS Although bioimpedance, ultrasound and volumetric measures remained mostly unchanged, wrist mobility, pain perception, depression, and QoL were all significantly ameliorated after APA. CONCLUSIONS Our findings suggest that a multidisciplinary treatment approach involving APA professionals should be employed in the management of BC-related lymphedema to improve patient psychophysical outcomes and QoL.
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Affiliation(s)
- Giuditta Carretti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Daniela Mirandola
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,The Italian League Against Tumors (LILT), 50126, Florence, Italy
| | | | - Lisa Sequi
- The Italian League Against Tumors (LILT), 50126, Florence, Italy
| | - Sara Germano
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Grazia Muraca
- Oncological Rehabilitation Centre (Ce.Ri.On.), 50139, Florence, Italy.,Oncological Network, Prevention and Research Institute (ISPRO), 50139, Florence, Italy
| | - Guido Miccinesi
- Oncological Network, Prevention and Research Institute (ISPRO), 50139, Florence, Italy
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Mirca Marini
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia. Obstet Gynecol 2021; 137:924-934. [PMID: 33831939 DOI: 10.1097/aog.0000000000004352] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia. METHODS Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation. RESULTS Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001). CONCLUSION Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.
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de Godoy JMP, de Godoy HJP, Guimarães TD, Godoy MDFG. Treatment for chest pain intercurrence after breast cancer surgery using Godoy's intermittent skin therapy. Int J Health Sci (Qassim) 2021; 15:42-45. [PMID: 34548862 PMCID: PMC8434843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Chest pain and swelling are routinely reported in women after breast cancer treatment and are often not valued by health professionals. In general, these patients suffer and without many effective solutions. The aim of the present study was to report the results of a novel technique for the treatment of chest pain related to breast cancer treatment. METHODS A clinical trial was conducted involving 25 women with chest pain resulting from the treatment of breast cancer and submitted to treatment for lymphedema at the Godoy School in 2018. Godoy's intermittent dermal therapy was performed on the participants 2-4 h/day for 2 days until the occurrence of a significant improvement or complete resolution of pain (measured using the visual analog pain scale). RESULTS All patients reported a significant reduction in pain in the first ½ h of treatment (P < 0.0001, Wilcoxon signed-rank test). Six of the 25 patients (24%) reported the absence of pain after treatment on the 1st day and all (100%) reported the absence of pain at the end of treatment on the 2nd day. CONCLUSION Chronic chest pain in patients having been submitted to treatment for breast cancer can be significantly reduced with Godoy's intermittent skin therapy, achieving standards of normality or near normality within only a few sessions.
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Affiliation(s)
- Jose Maria Pereira de Godoy
- Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto School of Medicine (FAMERP), CNPq (National Council for Research and Development), Sao Jose do Rio Preto, Brazil,Address for correspondence: Jose Maria Pereira de Godoy, Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto School of Medicine (FAMERP), CNPq (National Council for Research and Development), Sao Jose do Rio Preto, Brazil. Tel-Fax: +551732326362. E-mail:
| | - Henrique Jose Pereira de Godoy
- Physician, Medical Degree from Universidade Federal do Mato Grosso-Cuiabá-UFMT and Member Clínica Godoy Research Group, Sao Jose do Rio Preto, Brazil
| | - Tania Dias Guimarães
- Physiotherapist Member Clínica Godoy Research Group, São Jose do Rio Preto, Brazil
| | - Maria de Fatima Guerreiro Godoy
- Occupational Therapist, Professor in Graduate Program of São José do Rio Preto School of Medicine (FAMERP) and Member Clínica Godoy Research Group, Sao Jose do Rio Preto, Brazil
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Living with leg lymphedema: developing a novel model of quality lymphedema care for cancer survivors. J Cancer Surviv 2020; 15:140-150. [PMID: 32712757 PMCID: PMC7822774 DOI: 10.1007/s11764-020-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
Purpose Lower-extremity lymphedema (LEL) is a lifelong consequence of cancer therapy and can lead to serious physical and psychosocial complications for many cancer survivors. However, clinical knowledge and treatment of LEL remain minimal. The purpose of this study was to integrate perspectives of lymphedema patients and healthcare providers (HCPs) on LEL to develop a novel model for quality lymphedema care. Methods A mixed-methods approach was implemented. Standardized questionnaires and semi-structured interviews were used to assess psychosocial well-being and experiences of LEL patients. Interviews were also used to evaluate the clinical experiences of HCPs working within tumour groups associated with cancer-related LEL. Thematic analysis was used to analyse qualitative data. Results Twenty-two patients and eleven HCPs participated in this study. Patient QOL, generalized anxiety and depressive symptom scores revealed a complex interplay between psychosocial well-being and supportive LEL care after cancer. Three themes emerged from interviews with patients (n = 19) and HCPs (n = 11): level of lymphedema knowledge, effectiveness of rehabilitation oncology services and barriers to care. Implications for Cancer Survivors We developed a novel model for quality lymphedema care that emphasizes the importance of continued physical and psychosocial support for LEL patients, while illustrating the importance of HCPs in facilitating a smooth transition for patients to LEL care after cancer treatment. Electronic supplementary material The online version of this article (10.1007/s11764-020-00919-2) contains supplementary material, which is available to authorized users.
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8
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Bondalevich L, de Laplante S. A 61-year-old woman with chronic leg lymphedema managed with complete decongestive therapy. CMAJ 2020; 192:E708-E712. [PMID: 32601249 DOI: 10.1503/cmaj.190227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Larysa Bondalevich
- Alta Vista Chiropractic & Massage Clinic (Bondalevich), Ottawa, Ont.; Vodder Schools International (Bondalevich), North Vancouver, BC; Department of Family Medicine (de Laplante), University of Ottawa, Ottawa, Ont
| | - Stefan de Laplante
- Alta Vista Chiropractic & Massage Clinic (Bondalevich), Ottawa, Ont.; Vodder Schools International (Bondalevich), North Vancouver, BC; Department of Family Medicine (de Laplante), University of Ottawa, Ottawa, Ont.
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9
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Polan RM, Rossi EC, Barber EL. Extent of lymphadenectomy and postoperative major complications among women with endometrial cancer treated with minimally invasive surgery. Am J Obstet Gynecol 2019; 220:263.e1-263.e8. [PMID: 30521798 DOI: 10.1016/j.ajog.2018.11.1102] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with endometrial cancer, sentinel lymphadenectomy is used to accurately prognosticate extent of disease, and has been proposed as a method to decrease the incidence of medical and surgical complications associated with more extensive lymphadenectomy. It is unknown whether patients who undergo traditional lymphadenectomy experience major postoperative complications at the same rates as those who undergo sentinel lymphadenectomy or those who do not undergo lymphadenectomy. OBJECTIVE The aim of this study was to compare the incidence of major postoperative complications among endometrial cancer patients undergoing total laparoscopic hysterectomy with traditional lymphadenectomy vs sentinel or no lymphadenectomy. MATERIALS AND METHODS Patients with endometrial cancer who underwent total laparoscopic hysterectomy recorded in the National Surgical Quality Improvement Program (NSQIP) database between 2015 and 2016 were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Primary exposure was extent of lymphadenectomy. The primary outcome was major postoperative complications as defined by the Clavien-Dindo scale. Associations were examined with bivariable tests and multivariable logistic regression. RESULTS A total of 3282 women with endometrial cancer who underwent total laparoscopic hysterectomy were identified; of these, 2049 (62.4%) did not undergo lymphadenectomy, 1089 (33.2%) underwent traditional lymphadenectomy, and 144 (4.4%) underwent sentinel lymphadenectomy. Traditional lymphadenectomy had the highest rate of major complications (3.6%) compared with sentinel lymphadenectomy (2.0%) and no lymphadenectomy (2.0%) (P = .03). Patients who underwent traditional lymphadenectomy also had the longest operating room times and procedures that were most surgically complex (171 minutes, 30.6 relative value units [RVU]) compared with patients who underwent sentinel lymphadenectomy (166 minutes, 24.9 RVU) or no lymphadenectomy (141 minutes, 15.0 RVU) (all P < .001). Patients who underwent traditional lymphadenectomy had nearly twice the odds of a major complication (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.2-2.9) and need for readmission (aOR, 2.2; 95% CI, 1.5-3.4) compared to those who underwent sentinel or no lymphadenectomy. The incidence of readmission after traditional lymphadenectomy was higher (4.6%) than after sentinel lymphadenectomy (1.4%) and no lymphadenectomy (2.2%) (P < 0.001). CONCLUSION Sentinel lymphadenectomy among patients undergoing total laparoscopic hysterectomy for endometrial cancer was associated with a decreased incidence of major postoperative complications and need for readmission when compared with traditional lymphadenectomy.
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Early primary lymphoedema treated by en bloc excision: A case report. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Badash I, Gould DJ, Patel KM. Supermicrosurgery: History, Applications, Training and the Future. Front Surg 2018; 5:23. [PMID: 29740586 PMCID: PMC5931174 DOI: 10.3389/fsurg.2018.00023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Abstract
Supermicrosurgery, a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 mm, has revolutionized the fields of lymphedema treatment and soft tissue reconstruction. The technique offers several distinct benefits to microsurgeons, including the ability to manipulate small vessels that were previously inaccessible, and to minimize donor-site morbidity by dissecting short pedicles in a suprafascial plane. Thus, supermicrosurgery has become increasingly popular in recent years, and its applications have greatly expanded since it was first introduced 20 years ago. While supermicrosurgery was originally developed for procedures involving salvage of the digit tip, the technique is now routinely used in a wide variety of microsurgical cases, including lymphovenous anastomoses, vascularized lymph node transfers and perforator-to-perforator anastomoses. With continued experimentation, standardization of supermicrosurgical training, and high quality studies focusing on the outcomes of these novel procedures, supermicrosurgery can become a routine and valuable component of every microsurgeon's practice.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
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Abstract
The impact of chronic oedema on community nurses' work, the NHS and those directly affected by the condition is immense. As chronic oedema prevalence is projected to rise and financial austerity continues, innovative, sustainable solutions that ensure positive outcomes for patients must be found. This paper reports findings from a focus group (n=3) investigation of the effects of an innovative workplace education intervention designed to enhance community nurses' knowledge for practice in chronic oedema prevention and management in Wales. The main findings indicated that the programme had enhanced community nurses' awareness, knowledge and understanding of chronic oedema management. By enhancing their knowledge base, benefit might be conferred for patients with chronic oedema in terms of improved quality of life, self-efficacy and self-management. However, the magnitude of perceived benefit was variable and contingent on engagement with and support for self-management. Findings indicate the need for a longitudinal study.
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Affiliation(s)
- Tessa Watts
- Associate Professor, Department of Nursing, College of Human and Health Sciences, Swansea University
| | - Ruth Davies
- Honorary Associate Professor, Department of Nursing, College of Human and Health Sciences, Swansea University
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Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size. Int J Vasc Med 2017; 2017:8515767. [PMID: 28835857 PMCID: PMC5557258 DOI: 10.1155/2017/8515767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. Methods Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. Results On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). Conclusion Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.
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Herberger K, Blome C, Heyer K, Ellis F, Münter KC, Augustin M. Quality of life in patients with primary and secondary lymphedema in the community. Wound Repair Regen 2017; 25:466-473. [PMID: 28370792 DOI: 10.1111/wrr.12529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
Lymphedema is a complex and burdensome medical problem and requires continuous specific therapy. The aim of this cross-sectional study of community lymphedema care in the metropolitan area of Hamburg, Germany, was to evaluate health-related quality of life (QoL) in lymphedema patients. Generic as well as disease-specific health-related QoL was assessed using EQ-5D and FLQA-LK, respectively. Pain was assessed using a visual analogue scale (VAS). About 301 patients (median age of 60.5 years, 90.8% female) with lymphedema of any origin were included. About 66.4% had lymphedema, 24.1% combined lipolymphedema, and 9.5% lipoedema. Mean disease-specific QoL (FLQA-LK) was 2.4 (range 0 = no to 4 = maximum burden). The highest impairment values were observed in subscales for physical complaints, everyday life, and emotional well-being. Mean EQ-5D VAS was 70.4, mean EQ-5D score 63.3. Lymphedema was associated with major impairments in QoL, which differed for subgroups of pain, clinical severity, and comorbidity. Pain as a common problem for lymphedema patients seemed to be underestimated and undertreated. Early diagnosis and structured treatment strategies are urgently needed.
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Affiliation(s)
- Katharina Herberger
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Blome
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Heyer
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Ellis
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthias Augustin
- CVderm - German Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Reducing overtreatment: A comparison of lymph node assessment strategies for endometrial cancer. Gynecol Oncol 2016; 143:281-286. [DOI: 10.1016/j.ygyno.2016.08.323] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/23/2022]
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16
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Watts TE, Davies RE. A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics. J Adv Nurs 2016; 72:3147-3159. [PMID: 27400246 DOI: 10.1111/jan.13071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Tessa E. Watts
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
| | - Ruth E. Davies
- Department of Nursing; College of Human and Health Sciences; Swansea University; Wales UK
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17
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Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize? Case Rep Vasc Med 2016; 2016:5230634. [PMID: 27529050 PMCID: PMC4977388 DOI: 10.1155/2016/5230634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.
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18
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Stolldorf DP, Dietrich MS, Ridner SH. A Comparison of the Quality of Life in Patients With Primary and Secondary Lower Limb Lymphedema: A Mixed-Methods Study. West J Nurs Res 2016; 38:1313-34. [PMID: 27151079 DOI: 10.1177/0193945916647961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with lower limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients' quality of life by primary and secondary (cancer and noncancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey-Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence, χ(2)(df = 2) = 9.19, p = .010. Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower limb lymphedema experience psychosocial impairments and problems with quality of and access to care.
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19
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Deng J, Radina E, Fu MR, Armer JM, Cormier JN, Thiadens SRJ, Weiss J, Tuppo CM, Dietrich MS, Ridner SH. Self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema. J Nurs Scholarsh 2014; 47:126-34. [PMID: 25475008 DOI: 10.1111/jnu.12117] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purposes of this study were (a) to evaluate self-care, symptom burden, and reported infections among individuals with lower-extremity primary lymphedema; (b) to examine the differences in self-care, symptom burden, and reported infections between individuals with unilateral and those with bilateral lower-extremity primary lymphedema; and (c) to examine the associations among self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema. DESIGN A secondary data analysis was used. Data were collected from a cross-sectional survey study supported by the National Lymphedema Network from March 2006 through January 2010. The surveys were available both online and in hard copy in order to increase accessibility. METHODS Descriptive statistics were conducted and associations between variables were assessed using Mann-Whitney tests and chi-square tests of independence. Multiple logistic regression was used to test for associations while controlling for potentially confounding variables. FINDINGS A total of 803 participants reported having lower-extremity primary lymphedema. The majority of the participants were female (82.9%), White (74.2%), and from the United States (90.7%). Approximately two thirds of the respondents conducted some home daily lymphedema self-care. Over half of the respondents reported experiencing symptom burden and 44.8% reported at least one episode of infection. Compared to individuals with unilateral lower-extremity primary lymphedema, individuals with bilateral lower-extremity lymphedema were more likely to conduct skin care (p = .004), use alternative medications (p = .005), more frequently reported symptoms (p < .05), and more likely to report at least one episode of infection (p = .002). Respondents who reported use of compression garments also were less likely to have self-reported pain (p = .002), poor range of motion (p = .026), and numbness (p = .001). Participants who reported exercising also were less likely to have self-reported pain (p = .003). Participants who reported at least one episode of infection also reported experiencing more symptoms (p < .001). CONCLUSIONS Individuals with lower-extremity primary lymphedema experienced substantial symptom burden and infection episodes. Significant associations were identified among self-care, symptom burden, and reported infections. CLINICAL RELEVANCE The findings support the need for clinicians to educate patients with lower-extremity primary lymphedema regarding the importance of self-care, symptom management, and infection control. It is critically important for clinicians to evaluate symptom burden and reduce infections in individuals with lower-extremity primary lymphedema.
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Affiliation(s)
- Jie Deng
- Assistant Professor, School of Nursing, Vanderbilt University, Nashville, TN, USA
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20
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Synergistic effect of elastic stockings to maintain volume losses after mechanical lymphatic therapy. Dermatol Res Pract 2014; 2014:430636. [PMID: 25045349 PMCID: PMC4089942 DOI: 10.1155/2014/430636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
Abstract
The objective of the current study was to assess whether Venosan elastic stockings have a synergistic effect on the maintenance of results after Mechanical Lymphatic Therapy. Eleven patients with grade II lymphedema of the legs, regardless of cause, were evaluated in the Clinica Godoy between September and November 2012. The participants' ages ranged from 53 to 83 years old with a mean of 65.1 years. Two groups were formed with Group I using Venosan elastic stockings and Group II not using any type of compression therapy. Evaluations of the lymphedematous legs were performed before and after each drainage session using bioimpedance. Patients who wore elastic stockings had a greater volume reduction than those who did not wear stockings (unpaired t-test: P value < 0.001).
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21
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Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL): reliability and validity. Phys Ther 2014; 94:705-21. [PMID: 24415775 DOI: 10.2522/ptj.20130285] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients may develop primary (congenital) or secondary (acquired) lymphedema, causing significant physical and psychosocial problems. To plan treatment for lymphedema and monitor a patient's progress, swelling, and problems in functioning associated with lymphedema development should be assessed at baseline and follow-up. OBJECTIVE The purpose of this study was to investigate the reliability (test-retest, internal consistency, and measurement variability) and validity (content and construct) of data obtained with the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL). DESIGN This was a multicenter, cross-sectional study. METHODS The Lymph-ICF-LL is a descriptive, evaluative tool containing 28 questions about impairments in function, activity limitations, and participation restrictions in patients with lower limb lymphedema. The questionnaire has 5 domains: physical function, mental function, general tasks/household activities, mobility activities, and life domains/social life. The reliability and validity of the Lymph-ICF-LL were examined in 30 participants with objective lower limb lymphedema. RESULTS Intraclass correlation coefficients for test-retest reliability ranged from .69 to .94, and Cronbach alpha coefficients for internal consistency ranged from .82 to .97. Measurement variability was acceptable (standard error of measurement=5.9-12.6). Content validity was good because all questions were understandable for 93% of participants, the scoring system (visual analog scale) was clear, and the questionnaire was comprehensive for 90% of participants. Construct validity was good. All hypotheses for assessing convergent validity and divergent validity were accepted. LIMITATIONS The known-groups validity and responsiveness of the Dutch Lymph-ICF-LL and the cross-cultural validity of the English version of the Lymph-ICF-LL were not investigated. CONCLUSIONS The Lymph-ICF-LL is a Dutch questionnaire with evidence of reliability and validity for assessing impairments in function, activity limitations, and participation restrictions in people with primary or secondary lower limb lymphedema.
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Brown JC, John GM, Segal S, Chu CS, Schmitz KH. Physical activity and lower limb lymphedema among uterine cancer survivors. Med Sci Sports Exerc 2013; 45:2091-7. [PMID: 23657171 PMCID: PMC4122421 DOI: 10.1249/mss.0b013e318299afd4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Physical activity (PA) is known to provide physical and mental health benefits to uterine cancer survivors. However, it is unknown if PA is associated with lower limb lymphedema (LLL), an accumulation of protein-rich fluid in the lower limbs. Therefore, we sought to examine the association between PA and LLL in uterine cancer survivors, with a focus on walking. METHODS We conducted a cross-sectional study using mailed surveys among uterine cancer survivors who received care at a university-based cancer center. We asked about PA, walking, and LLL symptoms using validated self-report questionnaires. PA was calculated using MET-hours per week, and walking was calculated using blocks per day. RESULTS The response rate to our survey was 43%. Among the 213 uterine cancer survivors in our survey, 36% were classified as having LLL. Compared with participants who reported <3 MET · h · wk of PA, participants who reported ≥ 18.0 MET · h · wk of PA had an odds ratio of LLL of 0.32 (95% confidence interval, 0.15-0.69; P trend = 0.003). Stratified analyses suggested the association between PA and LLL existed only among women with body mass index (BMI) <30 kg · m (P trend = 0.007) compared with women with BMI ≥ 30 kg · m (P trend = 0.47). Compared with participants who reported <4.0 blocks per day of walking, participants who reported ≥ 12 blocks per day of walking had an odds ratio of LLL of 0.19 (95% confidence interval, 0.09-0.43; P trend < 0.0001). Stratified analyses suggested the association between walking and LLL was similar among women with BMI <30 kg · m (P trend = 0.007) and women with BMI ≥ 30 kg · m (P trend = 0.03). CONCLUSION Participation in higher levels of PA or walking is associated with reduced proportions of LLL in dose-response fashion. These findings should be interpreted as preliminary and should be investigated in future studies.
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Affiliation(s)
- Justin C. Brown
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, PA
| | | | - Saya Segal
- Division of Female Pelvic Medicine and Reconstructive Surgery; University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
| | - Christina S. Chu
- Divsion of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, PA
| | - Kathryn H. Schmitz
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, PA
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Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD. Multidisciplinary lymphedema treatment program. INT J LOW EXTR WOUND 2012; 11:20-7. [PMID: 22336900 DOI: 10.1177/1534734612438436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphedema is an underrecognized and undertreated condition that requires a multidisciplinary approach in an individualized program that will address the special needs of each patient. In an ideal setting of an outpatient management program the team should be composed of a vascular surgeon, a dermatologist, a physiotherapist, a dietician, a psychologist, a social worker, and an office employee, working together in the assessment and management of all aspects of lymphedema. All treatment strategies and actions taken should ultimately focus on the improvement of the quality of life of patients suffering from lymphedema and on the prevention of lymphedema in high-risk patients.
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