Common peroneal nerve injury as a complication of short saphenous vein surgery

Objectives: To determine the incidence of common peroneal nerve (CPN) injury following short saphenous vein surgery (SSV) in a UK district general hospital, and establish possible risk factors, and preventative strategies to minimize the risk of nerve injury following this type of surgery.

Methods: Retrospective review of all cases of SSV surgery performed in a single institution during the period January 2002–October 2004.

Results: Sixty-four patients underwent SSV surgery during the review period. Three patients (4.7%) developed a CPN injury postoperatively. One patient recovered fully after 24 h, whereas the other two patients' symptoms recovered within six months. All three patients had a saphenopopliteal junction (SPJ) located high above the popliteal skin crease.

Conclusions: CPN injury during SSV surgery occurs with an appreciable frequency. In view of this, there is a need for a revised approach to the management of SSV disease, possibly incorporating less-invasive techniques such as endovenous closure.

How do recovery advice and behavioural characteristics influence upper-body function and quality of life among women 6 months after breast cancer diagnosis?

GOALS OF WORK

After breast cancer treatment, women may experience significant and enduring problems relating to upper-body function (UBF) and quality of life (QoL). Women are often given advice to avoid problems, despite little scientific evidence to support or refute the advice given.

PATIENTS AND METHODS

This study addressed the relationships between recovery advice and subsequent behaviours on QoL (Functional Assessment of Cancer Therapy, Breast questionnaire) and UBF (Disability of Arm, Shoulder and Hand questionnaire) 6 months after treatment for unilateral breast cancer among a population-based sample of women residing in southeast Queensland (n=287).

MAIN RESULTS

Eighty-seven percent (n=249) of women reported that they received advice on facilitating arm function during their hospital stay, whereas 72% received subsequent recovery advice from medical and/or allied health professionals. Reported QoL and UBF were similar between groups, irrespective of advice received. Behaviours of interest included adherence to advice given, participation in breast cancer programmes and whether women had flight travel, used the treated side as much as the untreated side or had trauma, sunburn, injections and/or blood pressure readings on the treated side in the previous 6 months. QoL and UBF were highest among those who followed minimal advice, who used their treated side as much as their untreated side and who did not participate in any breast cancer programme (p<0.05).

CONCLUSIONS

The findings neither support nor refute current recommendations made to women with breast cancer, but rather raise questions about the value of this recovery advice. The study also provides novel findings regarding relationships between certain behaviours and QoL among breast cancer survivors.

Perceptions of upper-body problems during recovery from breast cancer treatment

Despite improved recognition recently, restrictions in upper-body movement continue to cause impairment and distress for many women long after breast cancer treatment. The purpose of this research is to investigate this issue through the perceptions of breast cancer survivors in the context of their everyday lives. Twenty-four women recruited from a private breast clinic in south-eastern Queensland, Australia, participated in a qualitative study. Discussion groups comprised women treated for breast cancer within the previous 18 months. Discussions centred on experiences of physical difficulties, follow-up support, arm lymphoedema and exercise therapy during the women's recoveries. Returning to normal activities for women after breast surgery was felt to take longer than either the women's or their physicians' expectations. Many women reported difficulties in upper-body tasks, which worsened simple everyday responsibilities. The physical impact leads to psychological strain, as the women are constantly reminded of their illness and the possibility they may never return to their full capacity. These upper-body difficulties may include discomfort while driving and sleeping, posture disturbances, reduced employability in physical work, and decreased ability to do housework and gardening. Having lymphoedema or the threat of developing it was very distressing for most women. The potential preventive role of physiotherapy-led exercises to prevent further decline and improve function was strongly emphasised during these discussions. Clinicians need to recognise that it is very common for women with breast cancer to experience upper-body morbidity long after their treatment, and consequently every effort to enhance recovery and avoid further deterioration in function is required.