• Physical Therapy Korea
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• v.6 no.3
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• pp.110-120
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• 1999

Lymphedema, regardless of etiology, is essentially incurable but different treatment approaches which serve to contain swelling exist. The objectives of treatment are to reduce swelling, restore shape, educate about the self-maintenance methods, and prevent inflammatory episodes, eg, recurrent cellulitis. The purpose of this report is to provide therapists and other medical staff with a general guideline through the example treatment procedure of two patients with lymphedema admitted to Samsung Medical Center. This study demonstrates the effects of the various treatments used and how they helped to achieve improvement in mobility and reduction in swelling of the lower limbs. The basic conservative treatments were sequential intermittent pneumatic pumps, elevation, and CDP (complex decongestive physiotherapy). The surgical procedures (Homan's operation) were carried out after maximal volume reduction through conservative programs. In these cases, we can see greater than 50% reduction in the lymphedema in those treated by conservative and surgical procedures. This presents a simple, reliable, variable method yielding satisfactory cosmetic and functional results for patients suffering from chronic both-leg lymphedema. Futhermore, I suggest that the outcomes are best when treatment is administered by a multidisciplinary team including a physiotherapist, surgeon, nurse, et al.

• The Journal of Korean Physical Therapy
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• v.21 no.4
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• pp.89-96
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• 2009

Purpose: This study examined the effects of manual lymph drainage (MLD) on edema and the quality of life (QOL) of lymphedema patients in the maintenance phase. Method: Forty five lymphedema patients, who had completed intensive decongestive therapy, were enrolled in this study. All subjects were assigned randomly to two groups: Experimental (MLD) group (n=23) and control (self-MLD) group (n=22). MLD by a specialist was applied with a comfortable pressure for 40~60 minutes in the experimental group and self-MLD was carried out by the control group 5 times a week for 2 weeks. The % edema and a SF-36 questionnaire were used to measure the decrease in edema and the QOL. A paired t-test was used to compare the period, and an independent T-test was used to compare experiment and control groups. Result: The % edema was significantly lower in the experimental group after MLD (p<0.05). The physical, vitality, and mental health scores of the experimental group was significantly higher than those of the control group (p<0.05). Conclusion: TMLD by a specialist in the maintenance phase is effective in reducing the % edema and enhancing the QOL of lymphedema patients. Further studies will be needed to determine if there are differences in the effects of many types of treatment methods in the lymphedema treatment.

• Parasites, Hosts and Diseases
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• v.46 no.3
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• pp.119-125
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• 2008

Lymphatic filariasis, transmitted by mosquitoes is the commonest cause of lymphedema in endemic countries. Among 120 million infected people in 83 countries, up to 16 million have lymphedema. Microfilariae ingested by mosquitoes grow into infective larvae. These larvae entering humans after infected mosquito bites grow in the lymphatics to adult worms that cause damage to lymphatics resulting in dilatation of lymph vessels. This earliest pathology is demonstrated in adults as well as in children, by ultrasonography, lymphoscintigraphy and histopathology studies. Once established, this damage was thought to be irreversible. This lymphatic damage predisposes to bacterial infection that causes recurrent acute attacks of dermato-lymphangio-adenitis in the affected limbs. Bacteria, mainly streptococci gain entry into the lymphatics through 'entry lesions' in skin, like interdigital fungal infections, injuries, eczema or similar causes that disrupt integrity of skin. Attacks of dermato-lymphangio-adenitis aggravates lymphatic damage causing lymphedema, which gets worse with repeated acute attacks. Elephantiasis is a late manifestation of lymphatic filariasis, which apart from limbs may involve genitalia or breasts. Lymphedema management includes use of antifilarial drugs in early stages, treatment and prevention of acute attacks through 'limb-hygiene', antibiotics and antifungals where indicated, and physical measures to reduce the swelling. In selected cases surgery is helpful.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.46-56
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• 2019

Background When performing lymphovenous anastomosis, it is sometimes difficult to find venules in the proximity of an ideal lymphatic vessel that have a similar diameter to that of the lymphatic vessel. In this situation, larger venules can be used. Methods The authors evaluated the efficacy of and patient satisfaction with lymphovenous bypass with sleeve-in anastomosis. Between January 2014 and December 2016, we performed this procedure in 18 patients (eight upper extremities and 10 lower extremities) with secondary lymphedema. Lymphovenous bypass with sleeve-in anastomosis was performed under microscopy after injecting indocyanine green dye. The circumferential diameter was measured before lymphovenous bypass and at 1, 2, and 6 months after the procedure. An outcomes survey that included patients' qualitative satisfaction with lymphovenous bypass was conducted at 6 months postoperatively. Results Almost all patients showed quantitative improvements after surgery. The circumferential reduction rate in patients with stage II lymphedema of both the upper and lower extremities was significantly greater than in their counterparts with stage III/IV lymphedema. The circumferential reduction rate was lower in lower-extremity patients than in upper-extremity patients. Conclusions Lymphovenous bypass surgery with sleeve-in anastomosis in lymphedema patients is beneficial, and appears to be effective, when adequately-sized venules cannot be found in the proximity of an ideal lymphatic vessel.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.288-304
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• 2023

Background Untreated lymphedema of an extremity leads to an increase in volume. The therapy of this condition can be conservative or surgical. Methods "Lymphological liposculpture" is a two-part procedure consisting of resection and conservative follow-up treatment to achieve curative volume adjustment of the extremities in secondary lymphedema. This treatment significantly reduces the need for complex decongestive therapy (CDT). From 2005 to 2020, 3,184 patients with secondary lymphedema after breast cancer and gynecological tumors were treated in our practice and clinic. "Lymphological liposculpture" was applied to 65 patients, and the data were recorded and evaluated by means of perometry and questionnaires. Results The alignment of the sick to the healthy side was achieved in all patients. In 58.42% (n = 38), the CDT treatment could be completely stopped postoperatively; in another 33.82% (n = 22) of the patients, a permanent reduction of the CDT was achieved. In 7.69% (n = 5) patients, the postoperative CDT could not be reduced. A total of 92.30% (n = 60) of the patients described a lasting significant improvement in their quality of life. Conclusion "Lymphological liposculpture" is a standardized curative sustainable procedure for secondary lymphedema for volume adjustment of the extremities and reduction of postoperative CDT with eminent improvement of the quality of life.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.sup3
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• pp.81-85
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• 2016

Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was $52.3{\pm}11.0years$ and of the control group was $50.1{\pm}10.9years$. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was $4.4{\pm}2.5cm$ and the difference in volume displacement was $528.7{\pm}374.4milliliters$. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI :2.6-73.3), invasiveness of BC (OR =13.7, 95% CI :7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI :2.3-7.9), BMI =>25 (OR=4.2, 95% CI :2-8.7), radiotherapy (OR=3.9, 95% CI :1.8-8.2), past history of limb damage (OR=1.7, 95% CI :0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI :1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in BC patients to prevent development of BCRL and improve QOL of these patients.

• Korean Journal of Adult Nursing
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• v.15 no.2
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• pp.316-326
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• 2003

Purpose: The purpose of this study was the development of a comprehensive nursing intervention program for the client with acute lymph stasis and stage I lymphedema. Method: The Quasi-experimental design using a non-equivalent control group was used. The subjects were 22 stroke patients with lymph stasis in the control group and 23 patients in the experimental group. The complex physical therapy of Casley-Smith was carried out to the control group for 10 hours, and comprehensive nursing intervention for the experimental group was carried out for 60 minutes. The data for this study was gathered from Feb. 2002 until June 2002 and pertains knowledge about lymphedema, self-care for managing lymphedema, and circumferences of affected limbs. Data was analyzed by mean, standard deviation, ${\chi}^2-test$, and t-test. Result: The changes in knowledge about lymphedema, self-care practices, and circumference of affected limbs after nursing intervention did not show significant differences between control group and experiment group. Conclusion: It can be concluded that comprehensive nursing intervention had more efficiency than complex physical therapy in the treatment of edema for stroke patients because of it's simplicity and time saving. Thereby, the comprehensive nursing intervention program developed in this study would be a useful therapy for the clients with lymph stasis and early stage lymphedema.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.16
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• pp.6535-6541
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• 2014

Background: To evaluate risk factors for upper extremity lymphedema due to breast cancer surgery. Materials and Methods: Clinical studies published on PubMed, Ovid, EMbase, and Cochrane Library from January 1996 to December 2012 were selected. Results: Twenty-five studies were identified, including 12,104 patients. Six risk factors related to the incidence of lymphedema after breast cancer treatment were detected: axillary lymph node dissection (OR=3.73, 95%CI 1.16 to 11.96), postoperative complications (OR=2.64, 95%CI 1.10 to 6.30), hypertension (OR=1.83, 95%CI 1.38 to 2.42), high body mass index (OR=1.80, 95%CI 1.30 to 2.49), chemotherapy (OR=1.38, 95%CI 1.07 to 1.79) and radiotherapy (OR=1.35, 95%CI 1.10 to 1.66). We found significant protective factors for lymphedema: pathologic T classification (OR=0.57, 95%CI 0.36 to 0.91) and stage (OR=0.60, 95%CI 0.39 to 0.93), while some factors, like age, number of positive lymph nodes, number of lymph node dissection, demonstrated no obvious correlation. Conclusions: Axillary lymph node dissection, postoperative complications, hypertension, body mass index, chemotherapy, radiotherapy are risk factors for lymphedema after breast cancer treatment. Attention should be paid to patients with risk factors to prevent the occurrence of lymphedema.

• Korean Journal of Adult Nursing
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• v.18 no.3
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• pp.386-394
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• 2006

Purpose: The purpose of this study was to provide nursing intervention with basic data extracted through investigating self-care and nursing of lymphedema in patient who have had a mastectomy. Method: The subjects for this study consisted of 214 mastectomy patients in 2 hospitals. The data were collected from December 1, 2004 to February 28, 2005. The instruments used for this study were both the Self-care Practice Scale by Cho, Myoung-Ok et al.(2003) which we modified and the Nursing Evaluation Scale developed by the researchers. Results: The mean score of self-care on lymphedema was $59.96{\pm}12.46$ The mean score of nursing was $25.64{\pm}9.25$ Factors influencing the self-care were the postoperative period (F=17.505, p<.001), the location of the tumor (F=3.826, p=.023), menstruation (t=7.333, p=.007), and complications (F=5.427, p<.001). Conclusion: Self-care and nursing care on the lymphedema management were shown to be lower than expected. Especially, the score of self-care was the lowest in the more than 3 year postoperative period. Therefore, the longer the postoperative period is, the more active management on lymphedema needs to be. Also, education should be given to both nurses and patients on the importance of self-care on lymphedema with mastectomies.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.4
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• pp.512-520
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• 2016

Breast cancer is the most common malignancy in women, and lymphedema is one of the most common postoperative complications of breast surgery. Exercises are usually prescribed to prevent this occurrence. On the other hand, conflicting results regarding the effects and timing of such exercises have been reported. This study reviewed systematically the contemporary literature, peer-reviewed publications, and web sites of professional organizations that examined exercise for lymphedema prevention or therapy to determine the effects of exercise on lymphedema providing the best evidence for the treatment of patients. Exercise or training groups have strategies that appear to reduce the development of secondary lymphedema and altering its progression compared to the control group. Advances in cancer treatment, cancer and exercise research, and lymphedema management require physicians to have a basic understanding of the current evidence to provide the appropriate patient education and specialist referral.