• Journal of Korean Academy of Nursing
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• v.36 no.5
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• pp.845-852
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• 2006

Purpose: The purpose of this study was to investigate the emotional state and related factors in patients with lymphedema. Methods: The subjects of this study consisted of 95 patients with lymphedema at 8 hospitals in Busan and Seoul. Data was collected by a self-administered questionnaire between March 2001 to December 2001. Data was analyzed by Pearson correlation coefficient, and stepwise multiple regression using SPSS Win 12.0. Results: The mean score of the emotional state of the subjects was 3.06; of their physical symptoms, 1.84; of their Activities of Daily Living(ADLs), 2.30; and of their social activities, 3.67. The emotional states of lymphedema patients correlated with their physical symptoms, their ADLs, and their social activities. The Factor influencing the emotional state of the subjects was social activities. Conclusion: These results suggest that a negative emotional state is very common in patients with lymphedema, to which appropriate attention should be given. Rehabilitation programs must be implemented to improve lymphedema patients' emotional state, physical symptoms, ADLs, and social activities.

• Women's Health Nursing
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• v.17 no.5
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• pp.474-483
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• 2011

Purpose: To examine the details of lymphedema, upper limb morbidity, and its self management in women after breast cancer treatment. Methods: Using a cross-sectional survey design, 81 women were recruited from a university hospital. Lymphedema was detected by a nurse as a 2-cm difference between arm circumferences at 6 different points on the arm. Degrees of pain, stiffness, and numbness were scored using a drawing of upper limb on a 0~10 point scale. Aggravating conditions and self-management for lymphedema were also recorded. Results: The mean age of the participants was 52.5 years; the average time since breast surgery was 29.7 months. Histories of modified radical mastectomy (55%) and lymph node dissection (81%) were noted. Lymphedema was found in 59% of women, then pain and stiffness were prevalent most at upper arm while numbness was apparentat fingers, and the symptom distress scores ranged 3.9~6.7. Women experienced aggravated arm swelling after routine housework with greatly varied duration. Self-management was conservative with a wide range of times for the relief of symptoms. Conclusion: Lymphedema education for women with breast cancer should be incorporated into the oncologic nursing care system to prevent its occurrence and arm morbidity. Risk reduction guidelines, individually tailored self-care strategies, and self-awareness for early detection need to be refined in clinical nursing practices.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.154-157
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• 2012

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.95-98
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• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Physical Therapy Rehabilitation Science
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• v.9 no.1
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• pp.43-48
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• 2020

Objective: Breast cancer-related lymphedema (BCRL) is a major sequela after surgery or radiotherarpy for breast cancer. Manual lymphatic drainage (MLD) is designed to reduce lymph swelling by facilitating lymphatic drainage. This study attempted to determine the histologic changes in the skin and subcutaneous layer, and the immediate effect of MLD in decreasing lymphedema using ultrasound imaging, which is the method used most commonly to eliminate BCRL. Design: A single-group experimental study. Methods: Five subjects who were diagnosed with hemiparetic upper extremity lymphedema more than six months after breast cancer surgery participated in the study. MLD was performed for 60 minutes in the order of the thorax, breast, axilla, and upper arm of the affected side. In order to determine the effect of MLD, ultrasound imaging and limb volume were assessed. Two measurement tools were used for asessing lymphedema thickness among the pretest, posttest, and 30-minute follow-up period. Results: Significant diferences in ultrasound imaging and upper limb volume were found between the affected side and non-affected side (p<0.05). On the affected side, although ultrasound imaging showed a significant decrease after MLD (p<0.05), there were no significant difference in upper limb volume when compared to the baseline. Conclusions: In this study, a significant decrease in lymphedema by MLD was demonstrated by ultrasound imaging, which is considered to be more useful in assessing histological changes than limb volume measurements. Further research on the protocol for eliminating lymphedema will be needed.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.3-8
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• 2020

Genital lymphedema (GL) is an uncommon and disabling disease that manifests as enlargement of the genital region resulting from the disturbance of lymphatic drainage. Although conservative treatment such as decompression is typically the first-line approach, surgical intervention has been shown to be effective in certain cases. This study aimed to systematically review studies evaluating available surgical alternatives for the treatment of male GL. A systematic search strategy using keyword and subject headings was applied to PubMed, Scopus, EMBASE, and Cochrane Library in May 2019. Studies investigating various surgical techniques to treat penile and scrotal lymphedema were included. The potential risk of bias of included trials was evaluated using the methodological index for non-randomized studies (MINORS). In total, 13 studies met the inclusion criteria, nine of which were determined to be high-quality. The average MINORS score was 12.45 for studies involving excision and 14 for studies involving lymphovenous anastomosis (LVA). The most common reason for a low score was a failure to describe the inclusion criteria. Recurrence of lymphedema during follow-up was reported in four studies involving excision and in no studies involving LVA. In general, the quality of the included literature was considered to be fair. Although surgical intervention might not always prevent the recurrence of lymphedema, all of the studies reported improved quality of life after the procedure. This study could be used as the basis for evidence-based guidelines to be applied in clinical practice for managing male GL.

• The Journal of Internal Korean Medicine
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• v.40 no.3
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• pp.343-355
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• 2019

Objectives: Traditional oriental medicine is used in treating breast cancer-related lymphedema to alleviate symptoms. Upper limb lymphedema is a symptom that is frequently observed in patients with breast cancer, and it impairs their quality of life. This systematic review aimed to summarize the current available evidence to evaluate the effect of traditional oriental medicine on upper limb lymphedema in breast cancer patients. Methods: The review evaluated randomized controlled trials (RCTs) measuring the effect of herbal medicine, acupuncture, and moxibustion on upper limb lymphedema in breast cancer patients within four electronic databases. The Cochrane risk of bias (ROB) tool was used to assess the quality of the RCTs. Results: In total, 23 RCTs met the inclusion criteria. Among them, 22 studies reported that the rate of severity of lymphedema improved after treatment in the traditional treatment group using herbal medicine, acupuncture, or moxibustion better than in the conventional medicine group. The methodological quality of the RCTs was insufficient with an unclear and high ROB. Conclusions: Traditional oriental medicine may have a potential to improve lymphedema in patients with breast cancer. To confirm the clinical recommendation, further research with a rigorous study design is required to support the effects of traditional oriental medicine.

• Physical Therapy Korea
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• v.6 no.1
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• pp.62-73
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• 1999

The purpose of this article was to provide basic knowledge and treatment principles of patient with lymphedema, which was usually not treated at all, or the treatment given didn't work efficiently. Lmphedema is defined as an abnormal accumulation of protein-rich fluid, edema, and chronic inflammation within an extremity. Lmphedema may be classified as either primary results from defects with aplasia, hypoplasia, and hyperplasia in the lymphatic system at birth or secondary is caused by known precipitating factors such as cancer, infection, inflammation, radiation, surgery, or trauma etc. There are essentially several conservative treatment methods which has been utilized successfully to treat lymphedema in Samsung Medical Center. We used following procedures: CPT (Complex Physical therapy) or CDP (Complex Decongesitive Physical therapy) such as skin care, MLD (Manual Lymph Drainage), compression with short-stretch bandage, exercise, elevation, elastic stocking, and pneumatic compression. Our experiences shows that conservative treatments can significantly reduce lymphedema and prevent different complications.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.689-695
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• 2022

Background Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping. Methods A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses. Result The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery. Conclusions The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.

• The Korean Journal of Rehabilitation Nursing
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• v.15 no.2
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• pp.117-125
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• 2012

Purpose: The purpose of this study was to develop and validate of a knowledge scale for lymphedema in patients with breast cancer. Methods: 34 preliminary items were made according to literature review, then verified content validity, construct validity, and reliability of the scale. 28 items among them were confirmed through content analysis by 4 experts. After a preliminary test, a survey for 156 breast cancer patients was performed for confirming construct validity and reliability. The data were analyzed using factor analysis, independent t-test, and KR-20. Results: This scale had 28 items consisting of 2 categories: prevention and self-care of lymphedema. Construct validity was confirmed by known-group technique because there were some categories consisted of just one or two items, and some mismatches between categories and items in factor analysis. Women who were educated about lymphedema scored significantly higher than women who had not (t=-3.92, p<.001). Reliability was appropriate (KR-20=.81). A percentage of correct answers was 74.6%, but it was from 31.8% to 96.1%. Conclusion: The study shows that this scale is reliable and valid to measure the knowledge of lymphedema. This scale can be effective to assess and educate the patients with breast cancer.