Bioengineering (Basel). 2023 Jan 22;10(2):149. doi: 10.3390/bioengineering10020149.

ABSTRACT

A healthy lymphatic system is required to return excess interstitial fluid back to the venous circulation. However, up to 49% of breast cancer survivors eventually develop breast cancer-related lymphedema due to lymphatic injuries from lymph node dissections or biopsies performed to treat cancer. While early-stage lymphedema can be ameliorated by manual lymph drainage, no cure exists for late-stage lymphedema when lymph vessels become completely dysfunctional. A viable late-stage treatment is the autotransplantation of functional lymphatic vessels. Here we report on a novel engineered lymphatic flap that may eventually replace the skin flaps used in vascularized lymph vessel transfers. The engineered flap mimics the lymphatic and dermal compartments of the skin by guiding multi-layered tissue organization of mesenchymal stem cells and lymphatic endothelial cells with an aligned decellularized fibroblast matrix. The construct was tested in a novel bilayered wound healing model and implanted into athymic nude rats. The in vitro model demonstrated capillary invasion into the wound gaps and deposition of extracellular matrix fibers, which may guide anastomosis and vascular integration of the graft during wound healing. The construct successfully anastomosed in vivo, forming chimeric vessels of human and rat cells. Overall, our flap replacement has high potential for treating lymphedema.

PMID:36829643 | PMC:PMC9952048 | DOI:10.3390/bioengineering10020149

J Interprof Educ Pract. 2023 Jun;31:100609. doi: 10.1016/j.xjep.2023.100609. Epub 2023 Feb 8.

ABSTRACT

Prior to 2020, healthcare professionals in the United States already had high rate of burnout. Since 2020, the COVID-19 pandemic created an urgent need for public health measures to effectively mitigate its negative health impacts. Despite these measures including vaccination, masking, handwashing, and physical distancing, people continue to be affected by post-COVID conditions (PCC) or newly acquired infections. Promoting one’s well-being and self-care, especially the methods that promote one’s relaxation and immune functions will serve as valuable tools among all healthcare practitioners and educators. For example, Kanpumasatsu, a skin rubdown using a dry towel, is simple to instruct, safe, and a cost-containing self-care approach that has the potential to promote relaxation and improve one’s immune functions. At the present moment, the evidence is limited and the mechanism of how kanpumasatsu improves immune functions has not been clearly documented. However, this author postulates this superficial massage causes the skin to stretch and enhances the lymphatic flow beneath the skin in a mechanism similar to that of lymphatic drainage massage. While the limited evidence of the health benefits of kanpumasatsu is available today, there is a potential for creating and enhancing instructional resources, conducting research and practice through awareness of kanpumasatsu among interprofessional educators and practitioners as a pilot self-care program to prevent burnout.

PMID:36776417 | PMC:PMC9905003 | DOI:10.1016/j.xjep.2023.100609

Cancers (Basel). 2023 Jan 9;15(2):426. doi: 10.3390/cancers15020426.

ABSTRACT

Axillary web syndrome (AWS) is a highly prevalent surgical complication affecting BC survivors. It presents as a subcutaneous cording that limits the upper limb range of motion (ROM) and causes pain. Its etiology is still debated, and its treatment is not well defined. Therefore, we aimed to investigate the safety, tolerability and efficacy of our specific AWS rehabilitative treatment protocol. We conducted an observational retrospective study on a cohort of 92 AWS patients referred to the oncological outpatient service of a university hospital. We collected data from medical records before (T0) and after (T1) the treatment. The studied protocol was composed of 60-min sessions, carried out 3 times/week by specialized physiotherapists, until the clinical resolution of AWS. We found that a mean of 8.74 ± 2.12 rehabilitative sessions were needed, and only one patient stopped early. At T1, shoulder ROM was complete in both abduction and flexion in 98% of patients; AWS was no longer detectable in 64% of them, and pain significantly decreased compared to T0. In conclusion, our protocol proved to be safe, well-tolerated and seemed to be effective in treating AWS.

PMID:36672375 | PMC:PMC9856526 | DOI:10.3390/cancers15020426

Eur J Breast Health. 2023 Jan 1;19(1):34-44. doi: 10.4274/ejbh.galenos.2022.2022-6-4. eCollection 2023 Jan.

ABSTRACT

OBJECTIVE: To compare the effects of low-level laser therapy, kinesio-taping and manual lymphatic drainage (MLD) on the affected arm volume, quality of life, arm function, neuropathic pain and shoulder mobility in patients with stage II breast cancer-related lymphedema.

MATERIALS AND METHODS: Forty-five breast cancer patients with stage II lymphedema were included. The patients were randomized to three groups and treated with MLD, kinesio-taping or low-level laser therapy. After these different therapeutic modalities, all patients received multilayer compression bandaging, lymphedema remedial exercises, skin care, and a patient education program by the same lymphedema therapist. All treatments were applied 5-days a week for three weeks. The lymphedema compression garments were prescribed to all patients and follow-up visits were planned at the end of the treatment, and at four and 12 weeks. The efficacy of the treatments was evaluated by volumetric calculations based on circumferential measurements using the formula for a truncated cone, in addition to goniometric assessments for shoulder joint ROM, and questionnaires: Quick-disability of arm, shoulder and hand for arm disability; pain-detect for neuropathic pain; and quality of life for arm lymphedema (LYMQOL-arm).

RESULTS: The baseline patient and disease characteristics, and outcome measures were similar between groups. All treatment modalities were found to be effective in decreasing arm volume, and improving quality of life, upper extremity disability and neuropathic pain. The percentage of decreased arm volume or treatment success was better in kinesio-taping group than in the MLD group at the end of the treatment, and at four and 12 weeks after treatment (p = 0.009, p = 0.039, and p = 0.042, respectively).

CONCLUSION: Kinesio-taping led to better results than MLD and was similarly effective compared with low-level laser in stage II breast cancer-related lymphedema at the twelfth week of follow-up. Kinesio-taping and low-level laser should be considered as alternative treatments in early-moderate stages of lymphedema. After these modalities, multi-layer compression and compression bandaging remain cornerstones of lymphedema treatment.

PMID:36605467 | PMC:PMC9806938 | DOI:10.4274/ejbh.galenos.2022.2022-6-4

2023 Nov 28. In: Swennen GRJ, editor. Minimally Invasive (MI) Orthognathic Surgery: A Systematic Step-by-Step Approach [Internet]. Cham (CH): Springer; 2023. Chapter 8.

ABSTRACT

To increase patient’s postoperative comfort and experience, to enhance fast recovery and decrease patient morbidity after minimally invasive (MI) orthognathic surgery, the overall conditions are also of major importance. In this chapter, important preoperative, perioperative, and postoperative considerations are outlined. Preoperatively, the orthognathic surgical workup in combination with clinical focused 3D virtual surgical planning (3D-VSP) is crucial. Perioperative considerations in regard to the surgical-anesthesiologic team, preparation of the operating room, surgical instrumentation table organization, patient preparation, hypotensive anesthesia, and adequate medication are described in detail. Last but not least, postoperative considerations such as patient and wound care, pain and postoperative nausea/vomiting (PONV) management, dietary support, thermo-therapy, manual lymphatic drainage (MLD), and close patient follow-up will be finally highlighted. In conclusion, besides MI orthognathic surgical techniques performed with delicate and dedicated MI orthognathic surgical instruments, a crucial part of the “Minimally Invasive Orthognathics Algorithm” remains the conditions described in this chapter in order to enhance quality of life (QoL) of patients with maxillofacial deformity undergoing orthognathic / orthofacial surgery.

PMID:38349986 | Bookshelf:NBK600307 | DOI:10.1007/978-3-031-38012-9_8

Indian J Palliat Care. 2022 Oct-Dec;28(4):439-442. doi: 10.25259/IJPC_78_2022. Epub 2022 Aug 25.

ABSTRACT

Lymphoedema is the accumulation of fluids with the high-protein content in the intercellular space, which is the most common complication seen in patients with breast cancer. In this study, we discuss the case of a 67-year-old female operated case of the left modified radical mastectomy in 2012. After 9 years, she had recurrence on the right side and diagnosed with metastatic breast cancer Stage 3 B. She developed lymphoedema on the same side for which she was referred to physiotherapy for further management. Along with radiation treatment, physiotherapy intervention such as complete decongestive therapy (CDT) for lymphoedema was initiated for 10 days which included multilayer lymphoedema bandaging, manual lymphatic drainage and exercise therapy. At the beginning, volume difference was 1688 ml then on the 5^th day, it was 1133 ml, and on the 10^th day, it was 802 ml noted. There was significant reduction in the volume of the involved limb that led to improvement in the score of sleep quality and quality of life (QOL). The major aims of CDT are to improve lymph circulation and to prevent lymphatic stasis which improves the QOL and sleep quality. Patient education and counselling along with home programme of bandaging played a major role in the recovery of the patient. CDT plays an important role in reducing lymphoedema and improving the sleep quality and QOL in metastatic breast cancer patient.

PMID:36447505 | PMC:PMC9699915 | DOI:10.25259/IJPC_78_2022

Eur J Vasc Endovasc Surg. 2023 Mar;65(3):406-413. doi: 10.1016/j.ejvs.2022.11.014. Epub 2022 Nov 17.

ABSTRACT

OBJECTIVE: With the rate of obesity increasing worldwide, patients with lymphoedema with and without a concomitant diagnosis of severe obesity (SO) were compared in regard to their baseline demographics, health related characteristics, treatment plans, and patient outcomes.

METHODS: This was a retrospective observational cohort study. The IBM MarketScan database was examined (2013 – 2019) for patients with a new diagnosis of lymphoedema. Of 60 284 patients with lymphoedema identified, 6 588 had SO defined by a body mass index > 40 kg/m². The demographics and other characteristics of SO were compared with patients with lymphoedema without SO.

RESULTS: SO and lymphoedema diagnosis increased two fold from 2013 to 2019. The lymphoedema SO+ group was younger (57.8 vs. 60.8 years, p < .001) and with a higher proportion of men (37.7% vs. 24.9%, p < .001) than the lymphoedema SO- group. More comorbidities were observed in the lymphoedema SO+ group than the lymphoedema SO- group: diabetes 46.0% vs. 24.9 % (p < .001), heart failure 18.3% vs. 7.4% (p < .001), hypertension 75.0% vs. 47.6% (p < .001), and renal disease 24.8% vs. 11.9% (p < .001). Use of diuretics in the lymphoedema SO+ group was greater: 57.6% vs. 38.0% (p < .001). Patients with lymphoedema SO+ had higher risk of cellulitis: 34.5% vs. 13.5% (p < .001). Specific lymphoedema treatment was given more often to lymphoedema SO-: 66.3% vs. 64.3% (p = .003). This was significant for manual lymphatic drainage (46.6% vs. 40.0%; p < .001) and physical therapy (55.4% vs. 51.6%; p<.001), but not for compression garments (18.2% vs. 17.7%; p = .38). However, more patients with lymphoedema SO+ received pneumatic compression device treatment: 20.9% vs. 13.7% (p < .001).

CONCLUSION: There was an increase in SO associated lymphoedema. Patients with lymphoedema SO+ have over a two and half fold increase in cellulitis incidence, with a significant increase in medical resource use and cost. Despite this, patients with lymphoedema and SO receive less specific therapy such as compression, which has proven to reduce cellulitis incidence.

PMID:36403939 | DOI:10.1016/j.ejvs.2022.11.014

Medicine (Baltimore). 2022 Oct 21;101(42):e30910. doi: 10.1097/MD.0000000000030910.

ABSTRACT

BACKGROUND: There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery.

METHODS: A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital.

RESULTS: The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group.

CONCLUSION: Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.

PMID:36281150 | PMC:PMC9592419 | DOI:10.1097/MD.0000000000030910

J Plast Reconstr Aesthet Surg. 2022 Nov;75(11):3946-3955. doi: 10.1016/j.bjps.2022.08.017. Epub 2022 Aug 24.

ABSTRACT

INTRODUCTION: The lower limbs are a common body site affected by chronic edema. Imaging examination of the lymphatic system is useful to diagnose lymphoedema, identify structural changes in individuals, and guide interventional strategies. In this study, we used a protocol combining indocyanine green (ICG) lymphography and ICG-guided manual lymphatic drainage (MLD) for the diagnostic assessment of lower limb lymphoedema.

MATERIALS AND METHODS: Patients with lower limb lymphoedema were divided into three groups by their medical history: primary, secondary cancer-related, or secondary non-cancer-related. ICG lymphography was conducted in three phases: initial observation, MLD to accelerate ICG dye transit and reduce imaging time, and imaging data collection. Lymphatic drainage regions were recorded, and the MD Anderson Cancer Center ICG staging was applied. We collected routine lymphoedema assessment data, including limb volume and bioimpedance spectroscopy measurements.

RESULTS: Three hundred and twenty-six lower limbs that underwent ICG lymphography were analyzed. Eight drainage regions were identified. The ipsilateral inguinal and popliteal were recognized as the original regions, and the remaining six regions were considered compensatory regions that occur only in lymphoedema. More than half of the secondary cancer-related lower limb lymphoedema (57.6%) continued to drain to the ipsilateral inguinal region. The incidence of drainage to the ipsilateral inguinal region was even higher for the primary (82.8%) and secondary non-cancer-related (87.1%) groups. Significant associations were observed between cancer-related lymphoedema and the presence of compensatory drainage regions.

CONCLUSIONS: We proposed a prospective ICG lymphography protocol for the diagnostic assessment of lower limb lymphoedema in combination with MLD. Eight drainage regions were identified, including two original and six compensatory regions.

PMID:36192315 | DOI:10.1016/j.bjps.2022.08.017

Cureus. 2022 Aug 25;14(8):e28374. doi: 10.7759/cureus.28374. eCollection 2022 Aug.

ABSTRACT

BACKGROUND: The manual lymphatic drainage (MLD) technique used during the early stages following surgical treatment of breast cancer can help prevent the progression of clinical lymphedema.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of manual lymphatic therapy (MLT) (Godoy method) in reducing the development of lymphedema immediately after breast cancer treatment.

METHOD: A randomized, blind, crossover, clinical trial was conducted involving 66 women with breast cancer-related lymphedema (BCRL), who underwent one hour of manual physical therapy and one hour of the control procedure. To evaluate the volume before and after the application of the MLT technique, volumetry, a water displacement technique was used. For statistical analysis, the paired t-test with 5% alpha error by Stats Direct 3(StatsDirect Ltd, Wirral, UK) was used.

RESULTS: A significant reduction in the volume of the limb was found in all patients (p-value = 0.0001, paired t-test).

CONCLUSION: MLT is effective in reducing lymphedema after breast cancer treatment.

PMID:36171826 | PMC:PMC9508690 | DOI:10.7759/cureus.28374