Complication Of Lymphedema Research Articles

Knowledge, Attitude, and Practice of Breast Cancer Patients Toward Lymphedema Complications: Cross-Sectional Study.

Breast cancer is commonly treated through surgical resection, but a common complication of the procedure is lymphedema of the upper limbs, which can significantly impact patients' daily life. This study aims to investigate the knowledge, attitude, and practice (KAP) of breast cancer patients with regard to lymphedema complications. This cross-sectional study was conducted by a self-administered questionnaire between August and October 2022 toward breast cancer patients in our Hospital of Traditional Chinese Medicine. A total of 529 breast cancer patients were enrolled, including 186 (35.16%) aged < 50years old. Participants had moderate knowledge, attitudes, and practices with scores of 18.24 ± 3.145 (possible range: 0-30), 62.24 ± 10.260 (possible range: 17-85), and 63.27 ± 20.967 (possible range: 21-105), respectively. Multivariate logistic regression showed that high school/technical secondary school (OR = 1.880, 95% CI = 1.107-3.194, P = 0.019) and being retired (OR = 0.482, 95% CI = 0.245-0.947, P = 0.034) were independently associated with good knowledge. Knowledge (OR = 1.321, 95% CI = 1.222-1.428, P < 0.001) was independently associated with a good attitude. Furthermore, knowledge (OR = 1.262, 95% CI = 1.151-1.384, P < 0.001) and attitude (OR = 1.122, 95% CI = 1.085-1.160, P < 0.001) were independently associated with good practice. Breast cancer patients have moderate knowledge, attitudes, and practices regarding lymphedema complications. Effective education and self-management programs are needed to improve patients' KAP toward lymphedema.

Lymphedema as first clinical presentation of Cantu Syndrome: reversed phenotyping after identification of gain-of-function variant in ABCC9.

Cantu Syndrome (CS), [OMIM #239850] is characterized by hypertrichosis, osteochondrodysplasia, and cardiomegaly. CS is caused by gain-of-function (GOF) variants in the KCNJ8 or ABCC9 genes that encode pore-forming Kir6.1 and regulatory SUR2 subunits of ATP-sensitive potassium (KATP) channels. Many subjects with CS also present with the complication of lymphedema. A previously uncharacterized, heterozygous ABCC9 variant, p.(Leu1055_Glu1058delinsPro), termed indel1055, was identified in an individual diagnosed with idiopathic lymphedema. The variant was introduced into the equivalent position of rat SUR2A, and inside-out patches were used to characterize the KATP channels formed by Kir6.2 and WT or mutant SUR2A subunits coexpressed in Cosm6 cells. The indel1055 variant causes gain-of-function of the channel, with an increase of the IC50 for ATP inhibition compared to WT. Retrospective consideration of this individual reveals clear features of Cantu Syndrome. An additional heterozygous ABCC9 variant, p.(Ile419Thr), was identified in a second individual diagnosed with lymphedema. In this case, there were no additional features consistent with CS, and the properties of p.(Ile416Thr) (the corresponding mutation in rat SUR2A)--containing channels were not different from WT. This proof-of-principle study shows that idiopathic lymphedema may actually be a first presentation of otherwise unrecognized Cantu Syndrome, but molecular phenotyping of identified variants is necessary to confirm relevance.

Prevention, Diagnosis, and Management of Upper Extremity Lymphedema Complications: Altmetric Analysis of Online Media.

Background:Traditional citation-based metrics do not capture the dissemination of upper extremity lymphedema (UEL) research that occurs online and in mainstream media. There is limited literature reporting the most impactful UEL articles based on citation rate and/or online mentions. We sought to use the Altmetric Attention Score (AAS) to determine the most impactful UEL articles in online media and to report trends in the diagnosis, treatment, and prevention of complications.Methods:The Altmetric database was queried to identify all published articles regarding the management, diagnosis, and prevention of complications seen in the setting of UEL. Extracted data points included article topic and type, journal, and number of online mentions on several platforms.Results:Our index search yielded 638 studies published between 2000 and 2021. Fifty articles with the highest AAS scores were included for analysis. The median AAS was 27.5, but the top four articles had AAS scores that were substantially higher (AAS ≥ 334) than all other studies. Of the top 50 articles, 68% (34/50) were original research. Of those, 23.5% (8/34) were randomized control trials. The most common article topic was the treatment of UEL (36%; 18/50) followed by diagnostic methods of UEL (30%; 15/50). There were a total of 1156 Twitter mentions (median:14) for the top 50 articles. Of all media platforms, news mentions correlated most strongly with AAS (R2 = 0.99, P < 0.001).Conclusions:Our findings suggest that alternative metrics measure distinct components of article impact and add an important dimension to understanding the overall impact of published research on UEL.

Stewart-Treves syndrome and other cutaneous malignancies in the context of chronic lymphedema: a systematic review.

Angiosarcoma developing in chronically lymphedematous tissue, or Stewart-Treves syndrome (STS), is a rare and lethal complication of lymphedema. This systematic review summarizes characteristics and outcomes of STS and other cutaneous malignancies arising in chronic lymphedema. MEDLINE and EMBASE databases were searched on February 19th, 2021, to identify 200 articles included in the analysis. Of 369 included patients, 89.7% (n = 331/369) had STS and 10.3% (n = 38/369) had other associated malignancies. Mean age of onset was 61.2 years, and 85.9% (n = 317/369) of cases were female. Common risk factors were previous cancer history (69.8%, n = 258/369) and radiation history (53.7%, n = 198/369). Lymphedema was most commonly attributed to surgical causes (68.3%, n = 252/369). STS begins on average 14.9 years after lymphedema with mortality of 53.9% (n = 178/331) and remission rate of 16.1% (n = 53/331). Other malignancies begin on average 23.7 years after lymphedema, with mortality of 10.5% (n = 4/38) and remission rate of 31.6% (n = 12/38). STS and other malignancies had 5-year survivals of 22.4% and 65.2%, respectively (P = 0.00145). For all patients, patients initially treated with excision had the best survival (median: 48 months, 5-year survival: 43.3%) and radiotherapy had the worst survival (median: 10 months, 5-year survival: 6.5%) (P = 0.0141). Malignancy can appear in lymphedematous tissue many years after lymphedema onset. STS has poorer prognosis compared to other malignancies. Further research should be conducted to better understand the causes, risk factors, and management of this phenomenon.

MON-116 Liposuction for Lipedema (Persistent Fat) in the US Improves Quality of Life

Purpose: Lipedema is a common and painful fat disorder affecting the limbs of women leading to obesity; the fat cannot be lost by diet or exercise, called persistent fat. Lipedema is classified by stage. Stage 1: normal skin surface with enlarged hypodermis. Stage 2: uneven skin with indentations in fat and larger hypodermal masses. Stage 3: large extrusions of tissue drastically inhibit mobility. Lymphedema occurs at any stage, especially Stage 3, called lipo-lymphedema. Reduction of lipedema fat is achieved effectively only by removal of fat by lymph-sparing liposuction. Liposuction reduction of fat on the lower body improves mobility. Data from Europe demonstrate quality of life improves for women with lipedema after liposuction. There are no data on liposuction and lipedema in the United States (US). The purpose of this study is to determine how women with lipedema in the United States benefit or not from liposuction. Materials and Methods: Non-validated 183-item online questionnaire answered by women after undergoing liposuction for lipedema in the US. Results: One-hundred and eighty-nine women with lipedema consented and answered the questionnaire; the majority (51%) Stage 2. Women with Stage 1 and 2 had on average two procedures; women with Stage 3 or lipo-lymphedema had, on average, one additional procedure. Improvement in ambulation after liposuction was highest in patients with lipedema Stage 3 at 90.9% and lowest in Stage 1 at 71%, where ambulation pre-surgery tends to be less affected. Weight loss occurred in all groups 2-4 months after liposuction. Women from all stages reported growth of fat post-procedure outside areas of liposuction, highest in Stage 1 (62%) and lipo-lymphedema (70%). Growth of fat in liposuction areas occurred in ~1/2 of participants across all groups, most often in women in lipedema Stage 4 (71%). The complication of lymphedema after liposuction was not reported in Stage 1 but in two women with Stage 2, five with Stage 3, and three with lipo-lipedema. Improved quality of life after liposuction was significant in Stages 1-3 ranging from 81% improvement for Stage 1 to 86% for Stage 3, but only 70% for women with lipo-lymphedema. The perceived success of the procedure decreased with stage. Conclusion: Women with lipedema noticed improved ambulation after liposuction, likely due to removal of excess adipose tissue from the legs. Fat growth after liposuction was reported consistent with published data. Improvement in quality of life after liposuction agrees with European data, and greater perceived benefit in earlier stages emphasizes the importance of early detection of lipedema and earlier intervention with liposuction. Prospective studies are needed to assess quality of life, fat growth, weight loss and ambulation after liposuction in women with lipedema in the US.

Do surgical interventions for limb lymphoedema reduce cellulitis attack frequency?

Recurrent cellulitis is a frequent and challenging complication of lymphoedema. British Lymphology Society cellulitis guidelines state that decongestive lymphatic therapy reduces the frequency of cellulitis attacks, but do not mention the effect of surgical interventions. This systematic review aims to assess whether surgical interventions for lymphoedema reduce the frequency of attacks of cellulitis. Embase, Medline, and the Cochrane database were searched for relevant articles from database inception to January 2016. Four hundred and thirty-six abstracts were retrieved. Studies were included which contained quantitative data on cellulitis incidence before and after a surgical intervention. Two independent reviewers applied selection criteria, selecting 27 papers for full text review. Two were unavailable in the UK from any source. A variety of surgical techniques were utilized in the 25 papers included: lymphaticovenous anastomosis, superficial-to-deep lymphaticolymphatic anastomosis, lymph node transfer, Charles procedure, muscle flap transfer, Homan's procedure, and subcutaneous tissue excision below skin flaps. Five studies combined techniques. One study compared the intervention to a control group (physical therapy). Cellulitis incidence was decreased following surgical intervention in 24/25 studies included. Eight had quantifiable reductions in cellulitis over a set follow-up period; in the other 16 preoperative incidence was not precisely defined. Surgery appears effective at reducing cellulitis incidence in lymphoedema. However, high quality evidence from randomized controlled trials is lacking. Future research should concentrate on comparison with control groups, for example compression alone versus compression with surgical intervention, in patients with lymphoedema and greater than two attacks of cellulitis per year.

Breast cancer survivors' perspectives of critical lymphedema self-care support needs.

To solicit breast cancer survivors' perspectives on the variety of issues they face related to lymphedema self-care and identify support needs perceived as critical for managing their chronic medical condition. Twenty-one breast cancer survivors with lymphedema participated in audio-recorded focus groups about barriers and facilitators of self-care. Transcripts were analyzed using ATLAS.ti software by two coders. Triangulation of findings provided for refinement and category confirmation. Themes identified included lack of social support, lack of resources for self-care activities, and self-advocacy by default. Lack of social support subthemes were feeling misunderstood, minimization of needs, and feeling criticized. Lack of resources for self-care activities subthemes were lack of both tangible self-care support and self-care supplies. Self-advocacy by default subthemes were the need to proactively manage lymphedema complications, the need to educate health-care workers, and feeling marginalized by the health-care system. Lack of support and the failure of others to recognize lymphedema as a chronic condition set this patient population apart from other patients with chronic diseases and decreases the amount of help needed to manage the condition.

Laser CO2 treatment for vulvar lymphedema secondary to gynecological cancer therapy: A report of two cases and review of the literature.

Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO2 excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO2 surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.

A Novel Approach to Lymphedema Management in Upper Extremity Amputations: A Case Report

Many breast cancer survivors experience lymphedema complications from past medical management procedures such as axillary lymph node dissections and/or radiation therapy. These complications negatively affect the patient’s health and overall quality of life. Occupational therapists (OT) certified in lymphedema management can contribute to positive patient outcomes as part of a comprehensive medical team. A case is presented of a 73-year-old female post voluntary trans-humeral amputation due to radiation induced brachial plexopathy. This patient’s treatment was led by an OT certified in lymphedema management and included complete decongestive therapy and analysis of function with a focus on the development of a novel compression garment to support patient self-management.

Carcinoma erysipeloides mimicking radiation dermatitis – a case report and review of literature

Carcinoma erysipeloides (CE) is a relatively rare variant of cutaneous metastasis more often observed in breast cancer than in other carcinomas in women. Clinically, it appears as a well-defined, warm and tender inflammatory erythematous plaque, thus mimicking Erysipelas, Cellulitis or post mastectomy complications of lymphedema and acute radiation dermatitis. We report a case of CE in a women previously treated for infiltrating ductal carcinoma by modified radical mastectomy, chemotherapy and radiotherapy. An early and accurate differential diagnosis of this disease gives the opportunity to diagnose and halt the systemic spread of the cancer.

English

Little attention has been given to the impact of long standing lymphedema and its complications. AIM: The aim of the study was to prepare a profile of long standing lymphedema complications PATIENTS AND METHODS: A total of 88 patients with lymphedema were included in this hospital based descriptive study. The study was designed to include age, sex, etiology, duration, prophylaxis and complications observed in each patient and entered into a proforma separately. RESULTS: A total of 88 cases studied, 74 cases are lower limb and 14 cases are upper limb lymphedema. Among 74 cases of lower limb lymphedema 4 cases occurred after inguinal lymphadenectomy and upper limb lypmhedema are secondary to postmodified radical mastectomy. A total of 40 cases in 88 patients had complications of lymphedema, among 88 cases studied 54 male and 34 were female patients 29 patients had cellulitis 3 patients had infected ulcer with maggots and 1 patient had lymphoma, among 88 patients 50 patients was on regular benzathine pencillin prophylaxis. Incidence of complications is 37.5 percent and incidence of complication in patient on penicillin prophylaxis 28.4 percent. Our study does not show no significant statistical correlation between benzathine prophylaxis and occurrence of complications. (pvalue0.727). CONCLUSION: The study provided relevant information about complications of lymphoedema, Pencillin prophylaxis is not found effective in reducing recurrent cellulitis episodes in chronic lymphedema. In our series we found one case of lymphoma (Diffuse large cell lymphoma) developing in lymphedematous tissue of lower limb.

Stewart–Treves syndrome: A rare complication of lymphedema

Stewart–Treves syndrome: A rare complication of lymphedema

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

The “third“ circulation in human limbs – tissue fluid, lymph and lymphatics

ZusammenfassungDer Autor stellt die aktuelle Definition des lymphatischen Systems vor, wie ähnlich und abhängig es vom venösen System ist, was seine Zusammensetzung ist, wie Gewebeflüssigkeit und Lymphe zwischen Zellen und Blutzirkulation ausgetauscht wird, wie sich das in Lymphödemen ändert und im Besonderen, was die Biochemie der Gewebeflüssigkeit bzw. Lymphe ist, deren Druck und Fluss, die Histopathologie und die Lokalisation und schließlich, wie man die häufigsten Komplikationen bei Lymphödemen behandelt, die Dermatolymphangioadentitis.

Cantu syndrome and lymphoedema

Three female patients with Cantu syndrome were studied, two of whom were adults presenting with the complication of lymphoedema, as described earlier in a male patient with this syndrome. The aim of this study is to report the clinical characteristics of these three new cases and to emphasize that lymphoedema, as observed in two of the patients described here, has been observed in 11.5% of patients with Cantu syndrome and that heterochromia iridis, observed in one patient, is probably a new feature of this condition.

Traitement des lymphœdèmes des membres

The treatment of lymphedema aims to reduce the volume and prevent infectious and joints mobility complications. This treatment rarely cure and is usually symptomatic; thus it should be continued throughout the life. The erysipelas and lymphangitis are common complications of lymphedema. Erysipela is always of streptococcal origin and requires systemic antibiotics. The risk of recurrent erysipelas on lymphedema is high. In case of large swelling associated with significant dermal sclerosis, it may lead to decrease joint mobility and functional impairment. The skin cares, manual lymph drainage, compression therapy with bandages and exercises are the four pillars of the complex decongestive therapy of limb lymphedema. Compression is the most important treatment. Lymphedema can be improved by only bandages, but a sustained improvement of lymphedema cannot be seen without bandages. The effectiveness of treatment must be evaluated by objective methods, measuring the perimeters of members or volumes. The management of lymphedema includes three phases: attack or initial treatment that aims to reduce volume of the lymphedema and maintenance phase to maintain the result and finally withdrawal phase. In the attack phase, we use complex decongestive therapy, mainly multilayer inelastic bandaging and manual lymphatic drainage (MLD). In the maintenance phase, we use elastic compression (stockings or sleeves) possibly associated with MLD. At all stages skin care and exercises are used. Adjuvant treatments may be useful (intermittent pneumatic compression, drug treatment). Surgery is rarely used except for genital lymphedema. The therapeutic management of lymphedema is difficult but has a variety of techniques. The complex decongestive therapy is very effective to restore a better quality of life even though it does not provide a cure for lymphedema.

Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?

IntroductionSecondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients’ mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage.Patients and methodsWe performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Medical Center Ljubljana, from January 2002 to June 2010. The patients’ demographic and medical data were collected, including type of cancer, type and stage of lymphedema, and time to first therapy of lymphedema. The number of referred patients with lymphedema following the therapy of melanoma, breast cancer, and uterine/cervical cancer, was compared to the number of patients expected to experience lymphedema following cancer therapy, calculated from the incidence reported in the literature.ResultsIn the period of 8.5 years, 543 patients (432 females, 112 males) with lymphedema were treated. The results show that probably many Slovenian patients with secondary lymphedema following cancer therapy remain unrecognized and untreated or undertreated. In the majority of our patients, the management of lymphedema was delayed; on average, the patients first received therapy for lymphedema 3.6 years after the first signs of lymphedema.ConclusionsTo avoid a delay in diagnosis and therapy, and the complications of lymphedema following cancer therapy, the physician should actively look for signs or symptoms of lymphedema during the follow-up period, and promptly manage or refer the patients developing problems.

Incidence, Treatment Costs, and Complications of Lymphedema After Breast Cancer Among Women of Working Age: A 2-Year Follow-Up Study

This study estimated the economic burden of breast cancer-related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors. We used claims data to study an incident cohort of breast cancer patients for the 2 years after the initiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis. Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema. Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference. Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.

Erysipelas-like inflammation following breast surgery

Impaired lymph drainage is an inevitable consequence of any form of surgery that disrupts lymphatics, resulting in a degree of lymphoedema that may vary from subtle to dramatic and although classically involving an entire limb, may be more localised, confined to only a small area such as a skin flap. Infection is a well-recognised complication of lymphoedema. However, not all inflammatory episodes occurring in the setting of lymphatic dysfunction can be clearly attributed to infection as this article demonstrates. Five patients presented over a 5-year period with distinctive erysipelas-like inflammation affecting the breast which occurred several weeks following reduction mammaplasty in four patients and breast reconstruction in one patient. No clinical response was obtained with standard antibiotics. This inflammatory problem may represent a previously unreported complication of breast surgery with an incidence of 4% following reduction mammaplasty. Recent research supports the notion that this type of episode is most likely to be due to a non-infective inflammatory process related to lymphatic dysfunction induced by surgery.

Erysipelas of the upper extremity following locoregional therapy for breast cancer

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.