Treatment Of Lymphedema Research Articles

The Concept of Palliative Lymphaticovenular Anastomosis.

Introduction: Lymphaticovenular anastomosis (LVA) is the first-line surgical treatment for lymphedema. The therapeutic effects of LVA, including edema reduction and cellulitis prevention, vary among patients. We examined cases of palliative LVA in patients with lymphedema who were in the terminal stage due to recurrence or distant metastasis of the primary disease, with a focus on the course and usefulness of palliative LVA. Methods and Results: A total of 13 palliative LVAs were performed in 12 patients undergoing palliative treatment. LVA was performed without interfering with chemotherapy or radiation. Data on site and stage of edema, compression treatment status, number of anastomoses, percentage change in circumferential diameter (the total circumference at six locations was compared), treatment efficacy, and patient prognosis were collected. Edema was present in the upper and lower extremities of 10 and 2 patients, respectively. The average postoperative decrease in circumferential diameter was 8.6%. Psychological evaluation was based on the self-reports of patients, and 11 out of 12 patients showed improvement in their mental state. Two patients died during the observation period due to deterioration in the underlying disease. Conclusion: We reported our experience with palliative LVA in patients with advanced malignancies. Many patients had favorable physical and psychological outcomes. Surgery can be performed safely with appropriate planning based on the condition of the patients. Palliative LVA may be a treatment option for patients with recurrent or distant metastases of the primary disease who are refractory to edema treatment.

The reliability and quality of short videos as health information of guidance for lymphedema: a cross-sectional study

BackgroundThe prevalence of lymphedema is rising, necessitating accurate diagnostic and treatment information for affected patients. Short video-sharing platforms facilitate access to such information but require validation regarding the reliability and quality of the content presented. This study aimed to assess the reliability and quality of lymphedema-related information on Chinese short video-sharing platforms.MethodsWe collected 111 video samples addressing the diagnosis and treatment of lymphedema from four platforms: TikTok, Bilibili, WeChat, and Microblog. Two independent surgeons evaluated each video for content comprehensiveness, quality (using the Global Quality Score), and reliability (using the modified DISCERN tool). The videos from different sources were subsequently compared and analyzed.ResultsOut of 111 videos analyzed, 66 (59.46%) were uploaded by medical professionals, including breast surgeons, vascular surgeons, plastic surgeons, physical therapists, and gynecologists, while 45 (40.54%) were shared by non-medical professionals such as science bloggers, medical institutions, and lymphedema patients. Patient-uploaded videos received the highest engagement, with median likes of 2,257 (IQR: 246.25–10998.25) and favorites of 399 (IQR: 94.5–1794.75). 13 videos (11.71%) contained inaccuracies. Medical professionals’ videos generally showed higher content comprehensiveness, particularly those by plastic surgeons, compared to non-medical professionals. The GQS and modified DISCERN tool were used to assess video quality and reliability respectively, with medical professionals scoring higher on both metrics (z = 3.127, p = 0.002; z = 2.010, p = 0.044). The quality and reliability of recommendations provided by plastic surgeons surpassed that of other medical professionals (χ2 = 16.196, p = 0.003; χ2 = 9.700, p = 0.046). No significant differences in video quality and reliability were found among the three categories of non-medical professionals (χ2 = 3.491, p = 0.175; χ2 = 2.098, p = 0.350).ConclusionOur study shows that lymphedema-related videos on short video platforms vary widely in quality. Videos by medical professionals are generally more accurate and of higher quality than those by non-professionals. However, patient-uploaded videos often get more engagement due to their relatability. To ensure public access to reliable information, establishing basic standards for this content is essential.

Feasibility and efficacy of home-based lymphedema exercises for head and neck cancer patients at a safety net hospital.

Lymphedema therapy is an effective tool in mitigating head and neck lymphedema morbidity and long-term fibrosis. Studies have shown the efficacy of facility-based therapy; however, access can be limited by sociodemographic factors, including socioeconomic status and transportation. This study evaluates the feasibility and effectiveness of home-based lymphedema therapy in a socially vulnerable patient population. A retrospective chart review analyzed patients who underwent home-based lymphedema exercise regimen after training with a lymphedema-trained speech language pathologist between 2019 and 2022 at a tertiary academic medical center. Patient and cancer demographics were collected. Primary outcomes measured were quality of life surveys and diet status. Of the 27 patients included, 85.1% were in the two highest quintiles of neighborhood deprivation based on national Area Deprivation Index (ADI). Treatment breakdown included 78% who were treated with surgery, 96% completed radiation and 59.3% chemotherapy. Six months after initiating lymphedema therapy, most patients (59.3%) were compliant with exercises. Quality of life scores showed trends toward improvement, but only a decrease in condition-related anxiety at 3months (p=0.004) reached statistical significance. Improvement in diet was significant at 6 and 9months after initiation of treatment (p=0.020). Patient compliance rate demonstrates feasibility of home exercises for lymphedema treatment in a tertiary care setting with a socially vulnerable patient population. Home-based head and neck lymphedema treatment showed improvements in patient diet over time.

Lymphedema due to Podoconiosis in Brazil

Podoconiosis is a neglected tropical disease that causes a type of progressive, non-infectious tropical lymphedema. Aim: The aim is reported one case of the one woman that presented always having problems with allergies and “lumps” appeared on the hallux of the right foot; it resembled a callus, which never disappeared and increased in size. The physical exam revealed several hardened nodular lesions in both feet involving the soles. The patient was submitted to intensive treatment for lymphedema using the Godoy Method® for the lower limbs for five days. The nodules were hardened and constant from the beginning. However, intensive treatment led to a reduction in the volume of the lesions, enabling better plantar flexion and extension as well as a gain in ambulation. However, the characteristics of the evolution of the condition, symptoms and the occurrence of nodules on velvety skin with a mossy kept appearance because are characteristics of podoconiosis. Podoconiosis may have other causes beyond those reported in literature, likely related to the exposure of the limb and associated immunological abnormalities.

Successful Treatment of Primary Eyelid Lymphedema by Periorbital Lymphovenous Anastomosis: A Case Report

AbstractEyelid lymphedema is a rare condition that presents as persistent swelling and non-pitting edema of the eyelids. Treatment options for this disease are limited, including surgical debulking and medications, which do not achieve complete resolution. Few studies have demonstrated the use of lymphovenous anastomosis (LVA) in the preauricular area for eyelid lymphedema treatment. In this report, we demonstrate the successful treatment of primary eyelid lymphedema by performing multiple LVAs in the periorbital region, where dermal backflow was visualized using indocyanine green lymphography. A total of four LVAs were performed through two separate incisions at the lateral canthal area and lateral eyebrow in a patient with unilateral upper eyelid lymphedema that resulted in significant improvement without recurrence.

Lower extremity lymphedema in patients with gynecologic cancer: Validation of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) in German language and investigation of lymphedema real-world treatment

Abstract Purpose The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) is an established patient-reported outcome measure for lower extremity lymphedema (LEL) in gynecologic oncology. We aimed to validate the GCLQ in German language (GCLQ-GER) for lymphedema detection in German-speaking patients and also investigated real-world patterns of lymphedema treatment. Methods The GCLQ was translated from English into German in accordance with the standards of a professional translation process. Subsequently, the questionnaire was administered in a prospective observational study including 102 patients who had undergone lymph node dissection (LND) within gynecologic cancer surgery. Various test quality criteria were calculated for the GCLQ-GER. As gold standard of testing methods, patients were clinically evaluated for LEL, and limb volume measurements were taken. Further data for lymphedema treatment were collected in patients with lymphedema diagnosis. Results Patients with LEL had increased GCLQ-GER total scores (mean 7.27) compared to patients without LEL (mean 1.81), p < 0.001. High diagnostic accuracy was indicated by the large area under the receiver operating characteristics curve (AUC) of 0.874 (95% CI 0.802–0.946). Based on sensitivity and specificity values ≥ 79.0%, the GCLQ total score ≥ 4 was determined as the optimal cut-off value to identify LEL. Excellent internal consistency was demonstrated by Cronbach’s alpha of 0.876. The clinical examination revealed a LEL prevalence of 48.0% (n = 49), and 85.7% (n = 42) of these patients received treatment. Conclusion The GCLQ-GER is a valid and feasible patient-reported outcome measure for lymphedema detection in German-speaking gynecologic cancer survivors. Its clinical introduction could improve secondary prevention of lymphedema and real-world treatment.

The Effect of Increasing the Body's Core Temperature and Improving Blood Flow by Using Far-Infrared Rays Emitted from Functional Loess Bio-Balls.

Low-energy far-infrared rays (FIRs) are widely used in the treatment of wounds, lymphedema, and various vascular diseases, and various types of products that emit infrared rays are being used at home for patients with blood flow-related diseases without experimental evidence. Blood flow and epidermal temperature were measured while applying conductive heat and FIRs via an electric mat (non-intervention) or a loess bio-ball mat (intervention). In the control group (n = 30), there was a minimal change in blood flow and epidermal temperature in the right and left middle fingers (LMF, RMF) as the mat temperature gradually increased. In the experimental group (n = 30), when the mat temperature increased from 25 °C to 50 °C, the blood flow increased by 39.80% in the LMF and by 41.83% in the RMF. In addition, the epidermal temperature increased by 8.78% in the LMF and by 8.44% in the RMF. The FIRs emitted from loess bio-balls can be applied to alleviate symptoms not only in patients with blood flow problems in medical settings but also in people who complain of discomfort due to blood flow disorders or cold hands and feet during their daily life and sleep.

Demonstration of the effectiveness of complete decongestive treatment in secondary lymphedema developing after total knee arthroplasty.

The aim of the current study is to demonstrate the treatment results of patients with lymphedema that developed after total knee arthroplasty (TKA) and to compare these results with those of patients with secondary lymphedema non-TKA. A total of 63 patients diagnosed with secondary lymphedema and who received complete decongestive treatment (MLD + bandaging + exercise) at the lymphedema treatment unit of Istanbul Physical Medicine and Rehabilitation Training Research Hospital between June 1, 2023, and February 1, 2024, were included in our retrospective study. The circumference of both metatarsophalangeal joints was measured, and leg diameter measurements were made from the lateral malleolus to the proximal 10th, 20th, and 30th centimeters. Of the 63 patients included in this study, the average age in the TKA group (n = 17) was 69.23 ± 8.27years, and the BMI was 38.60 ± 6.52. In the non-TKA group (n = 46), the average age was 63.50 ± 14.05years, and the BMI was 34.57 ± 9.17. There was no statistical difference between the two groups in terms of demographic data, affected sides, and initial measurements of the patients (p > 0.05). The response to continued decongestive treatment was significantly higher in both the TKA and non-TKA groups (p < 0.05). However, there was no statistically significant difference in treatment response between the two groups (p > 0.05). Complete decongestive treatment is an effective method for treating lymphedema that develops after total knee arthroplasty. No difference in treatment response was found between patients with lymphedema following TKA and those with secondary lymphedema from other causes.

Unveiling global interest in lymphedema: A decade of search data through google trends global interest in lymphedema: A google trends analysis.

The increasing reliance on Internet search engines for health-related queries requires a thorough evaluation of the public's engagement with medical information. This study aims to analyze global trends in interest in lymphedema over the past decade using Google Trends (GT). A physiatrist with expertise in lymphedema management identified and analyzed 12 key search terms according to the International Society of Lymphology (ISL) guidelines. These terms included 'lymphedema swelling', 'lymphedema treatment', 'lymphedema stages', 'compression therapy for lymphedema', 'manual lymphatic drainage (MLD)', 'complete decongestive therapy (CDT)', 'pneumatic compression pump', 'lymphovenous anastomosis (LVA)', 'lymphedema surgery', 'liposuction for lymphedema', 'lymphedema prevention' and 'post-cancer lymphedema'. GT data was collected using filters set to 'web search', 'all categories', and 'worldwide' to provide a comprehensive overview. The analysis was conducted for two five-year intervals: 1 September 2014 to 31 August 2019 and 1 September 2019 to 31 August 2024. Relative search volume (RSV) was calculated for each term and compared to quantify changes over time. Significant increases in search activity were observed for 'lymphedema swelling', 'lymphedema treatment', 'lymphedema stages', 'manual lymphatic drainage', 'lymphedema surgery', and 'post-cancer lymphedema' in the second period (p = 0.001 for each). The average GT score increased from 19 in 2014-2019 to 29 in 2019-2024 (p = 0.001), reflecting a significant increase in public awareness and interest. The study shows a significant increase in global public interest in lymphedema and its minimally invasive treatments over the past 5years, suggesting a growing awareness of the condition. These findings highlight the need for improved patient education and research to meet the increasing demand for lymphedema care.

Incidence of cancer-related lymphoedema: a protocol for a living systematic review with meta-analysis

IntroductionGiven the projected rise in the incidence of cancer treatment-related conditions, such as lymphoedema, and the limited research on lymphoedema in cancers with poor prognoses, there is a need for...

Exploring the molecular mechanisms by which secretory phospholipase a2 regulates lymphatic endothelial cell dysfunction by activating macrophages.

This study offers new insights into the dual role of secretory phospholipase A2 (sPLA2) in lymphedema, highlighting its impact on lymphatic endothelial cell (LEC) functionality. Through transcriptomic analyses and co-culture experiments, we observed that sPLA2 has both protective and detrimental effects on human LECs (HLECs), mediated by macrophage activation. Our findings reveal that while low levels of sPLA2 promote LEC health, excessive sPLA2 leads to dysfunction, emphasizing the significance of the sPLA2/PLA2R axis and arachidonic acid metabolism (AA) in lymphedema pathology. The study suggests targeting sPLA2 and its downstream pathways as a novel therapeutic strategy for lymphedema, aiming to mitigate its progression by safeguarding HLEC integrity. This research underscores the importance of balanced sPLA2 activity in maintaining lymphatic vessel health and presents a new avenue for lymphedema management and treatment.

Developing new biomarkers and treatments for breast cancer-related lymphedema.

Developing new biomarkers and treatments for breast cancer-related lymphedema.

Clinical evaluation of AYUSH-SL in patients receiving mass drug administration for the treatment of chronic inflammatory lymphedema, a double blind, placebo controlled, multicentric study.

A 2.5-year placebo controlled double blind trial was conducted to investigate the safety and efficacy of AYUSH- SL, a poly- herbal Ayurvedic formulation on filarial lymphedema in different endemic areas of India. Lymphatic filariasis (LF) is caused by parasitic nematodes from Wuchereria bancrofti, Brugia malayi, or B. timori that are transmitted through mosquitoes. In Ayurveda, LF has been elaborately narrated under the heading Shlipada, and the literature also includes detailed therapeutic measures. The multicenter, prospective, parallel group interventional study of a total of 180 participants were recruited within the duration through competitive enrollment. Diagnosed cases of grade I and grade II filarial lymphedema of Grade I and Grade II (lower extremities) were included in the trial. The study group was treated with MDA and AYUSH-SL or its placebo tablet. The control group had received MDA and a matching placebo. The primary outcome measure was the reduction in edema calculated for analysis by percentage reduction from baseline at the 4th, 12th and 24th week. Secondary outcome measures included improved quality of life (QoL), which was assessed using the Lymphatic Filariasis Specific QoL Questionnaire, and prevention of recurrence of acute episodes, which was evaluated by investigating the presence and severity of episodes in the past 4 weeks. The water displacement method for the evaluation of the efficacy of the intervention was shown to be highly significant compared to the baseline value (right leg; 3071.60 ± 970.482, 2828.40±829.339, p<0.001and Left leg; 3158.69 ± 1136.391, 2890.73 ±1077.475, p<0.001). There was significant improvement of Quality of Life in the LF QoL Questionnaire (p <0.001) at each follow-up visit in both groups. Safety estimations on hematologic and biochemical parameters were within limits and or changes were not significant. The results revealed that AYUSH- SL is safe and effective for FL due to its comprehensive anti-inflammatory, antimicrobial, and anti-allergic activities.

Safety Evaluation of a Device for Treatment of Lymphedema of the Upper Extremity.

Lymphedema is a chronic condition characterized by dysfunction of the lymphatic system. There is currently no available cure. The standard of care is complete decongestive physiotherapy performed by a lymphedema therapist. However, lymphedema may flare between appointments, making home care important. There are several medical devices available to treat lymphedema at home, but they can be expensive, noisy, and bulky, restricting patient mobility. Thus, there is a demand for other devices that can be utilized at home, between appointments. The overall goal of this research study is to assess the safety of a newly developed vibratory device that may be utilized to supplement lymphedema treatment. Fourteen healthy subjects were recruited and treated with the device, all while measuring pre-treatment and post-treatment upper extremity circumference/induration, vital signs, pain, side effects, and intra-treatment acceleration produced by the device. There were no significant changes in reported pain or vital signs, and side effects were largely mild and transient. We believe that this device is safe for use in healthy subjects, and further studies should assess the efficacy of this device in treating patients with lymphedema.

A novel non-pneumatic compression device results in reduced foot and ankle swelling in patients with venous and lymphatic edema.

Non-pneumatic compression devices (NPCDs) rely on shape-memory alloy technology that allows patients to ambulate and remain active during lymphedema treatment. This study examines the effect of the NPCD on foot and ankle swelling. This was a prospective, non-randomized study of patients with phlebolymphedema (venous insufficiency-related lymphedema) treated with a novel NPCD for 4 weeks. Ankle and foot circumference (cm), and volume measurements (ml water displacement using immersion) of the foot and ankle were obtained at enrollment, 2-weeks, and 4-weeks, and ambulation was tracked with a wearable exercise monitoring device. This study included 13 patients (21 limbs). A significant reduction in circumference (ankle (-0.84 ± 0.22cm, p < .01) and metatarsal bed (-0.55 ± 0.95, p < .01)) and volume (foot/ankle (-52 ± 22mL, p = .032)) was observed. Patients reported a mean of 8100 steps per day (±6100). NPCD results in significant reduction in edema in the foot and ankle despite garments lacking a foot piece. Patients remained mobile while adhering to therapy.

Modern surgical treatments for lymphedema.

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.

Promoting self-management in lymphoedema: the role of the community nurse.

Many of the approaches for managing lymphoedema are straightforward and easily accessible, allowing individuals to take considerable charge of their care. As a result, nurses can play a vital role in lymphoedema treatment by equipping patients with crucial knowledge and offering practical assistance to foster self-management. Francesca Ramadan elaborates upon the aspects of patient education that the community nurse must promote and support to enable individuals with lymphoedema to take back control.

Microsurgical Treatment of Primary Lymphedema: A Systematic Review and Meta-analysis

Microsurgical Treatment of Primary Lymphedema: A Systematic Review and Meta-analysis

Long-term Results of Lymphedema Treatment with combined Lymph Node Transfer and Collagen Scaffolds: An observational study

Aim: Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial-cell migration towards the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aims to examine the hypothesis that nanofibrillar collagen scaffolds (NCS) combined with VLNT can provide guided lymphagiogenesis creating long-lasting lymphatic pathways.Methods: Twenty-four patients (21 female, 3 male) who had undergone a lymphatic microsurgery for upper (n=11) or lower (n=13) limb secondary lymphedema and completed at least 18months follow up were selected and equally divided in two groups; Group-A underwent a VLNT, Group-B a combined VLNT and NCS procedure. Lymph-node flap sizes, harvesting procedure and implantation location were resembling in both groups. Demographics, lymphedema etiology and staging, limb volumetry, and somatometric data were recorded. Pre- and postoperative data for limb-volume difference, infection episodes/year, and indocyanine-green (ICG) lymphography changes were documented in all patients.Results: Mean follow-up was 42 months24-60 in Group-A, and 27 months18-48 in Group-B patients. Demographic data, lymphedema etiology, and staging were comparable in both groups. Pre- and postoperative edema volume difference for Group-A was 36% and 25% (p<0.001), while in Group-B 33% and 14% (p=0.001) respectively. The mean number of infection episodes decreased in Group-A and B from 1.75 to 0.33 and from 2.17 to 0.42 per patient/year, respectively. ICG mean stage in Group-A was 3.58 pre- and 3 postoperatively (p=0.045), and 3.67 pre- and 2.08 postoperatively in Group-B (p=0.506). A statistically significant difference was found in postoperative volume difference between the two groups (p=0.008) as well as the postoperative ICG changes (p<0.001). ICG-lymphography demonstrated new lymphatic vessel formation at the location of NCS implantation.Conclusions: Long-term follow-up of the patients treated with a combined VLNT-NCS approach revealed a statistically significant improvement regarding volume reduction, infection episodes per year, ICG downstaging and new lymphatic vessel formation, compared to VLNT alone.

Collagen Hydrogel Loaded With 9-cisRA-Lip Is an Option for Treatment of Secondary Lymphedema after Surgery.

Background: Secondary upper limb lymphedema is easy to occur after breast cancer surgery, for which treatment is limited. 9-cis-retinoic acid (9-cisRA) has been demonstrated to increase lymphangiogenesis without enhancing tumor metastasis but has the disadvantages of poor water solubility, easy decomposition in light, unstable to heat, and short half-life. Methods: Based on this, 9-cisRA-Lip with a particle size of roughly 143 nm and high dispersibility was prepared by thin-film dispersion method and verified by Malvern Laser Particle Size Analyzer and electron microscopy. Results: In vitro, 9-cisRA-Lip demonstrated good biosafety and tumor safety, promoting the proliferation of L929 cells while having no effect on 4T1 and Human Umbilical Vein Endothelial (HUVEC) cells. Compared with 9-cisRA, 9-cisRA-Lip was more effective at encouraging mouse lymphatic endothelial cell (SVEC4-10) migration, proliferation, and tube formation. In vivo, 9-cisRA-Lip-Gel showed good slow-release effect, mice treated with 9-cisRA-Lip-Gel one-time local injection had considerably less tail edema than the control group from day 9 to day 39 postsurgery (p < 0.05). This may be attributed to the greater capacity of 9-cisRA-Lip to enhance the phosphorylation of FGFR3 (Fibroblast Growth Factor Receptor 3) at Tyr 724. Conclusions: 9-cisRA-Lip-Gel presents a potential treatment option for lymphedema following surgery.