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The Journal of Surgical Research Dec 2014Lymphedema is a chronic debilitating condition and curative treatment is yet to be found. Tissue engineering approach, which combines cellular components, scaffold, and... (Review)
Review
BACKGROUND
Lymphedema is a chronic debilitating condition and curative treatment is yet to be found. Tissue engineering approach, which combines cellular components, scaffold, and molecular signals hold great potential in the treatment of secondary lymphedema with the advent of lymphatic graft to reconstruct damaged collecting lymphatic vessel. This review highlights the ideal characteristics of lymphatic graft, the limitation and challenges faced, and the approaches in developing tissue-engineered lymphatic graft.
METHODS
Literature on tissue engineering of lymphatic system and lymphatic tissue biology was reviewed.
RESULTS
The prime challenge in the design and manufacturing of this graft is producing endothelialized conduit with intraluminal valves. Suitable scaffold material is needed to ensure stability and functionality of the construct. Endothelialization of the construct can be enhanced via biofunctionalization and nanotopography, which mimics extracellular matrix. Nanocomposite polymers with improved performance over existing biomaterials are likely to benefit the development of lymphatic graft.
CONCLUSIONS
With the in-depth understanding of tissue engineering, nanotechnology, and improved knowledge on the biology of lymphatic regeneration, the aspiration to develop successful lymphatic graft is well achievable.
Topics: Humans; Lymphatic Vessels; Lymphedema; Nanotechnology; Regeneration; Tissue Engineering
PubMed: 25248852
DOI: 10.1016/j.jss.2014.07.059 -
Journal of Physiotherapy Oct 2022
Topics: Humans; Female; Breast Neoplasms; Lymphedema
PubMed: 36244958
DOI: 10.1016/j.jphys.2022.09.008 -
Hong Kong Medical Journal = Xianggang... Dec 2014Lymphoedema is a chronic, progressive condition. There is no cure but it is most easily managed with early recognition and therapy; those who do not have treatment tend... (Review)
Review
Lymphoedema is a chronic, progressive condition. There is no cure but it is most easily managed with early recognition and therapy; those who do not have treatment tend to worsen rapidly and advanced disease is more difficult to treat than early disease. Surgery for lymphoedema is often regarded as a last resort but traditional excisional techniques that have been slightly modified for modern practice have shown good results, whilst newer microsurgical reconstruction techniques show promise although long-term results are lacking. This report provides an update on the therapy of lymphoedema.
Topics: Humans; Lymphedema; Minimally Invasive Surgical Procedures; Physical Therapy Modalities
PubMed: 25170053
DOI: 10.12809/hkmj134116 -
International Journal of Environmental... Oct 2021Axillary web syndrome (AWS) is defined as a visible and palpable network of cords in the skin of the axillary cavity that are tensed by shoulder abduction following... (Review)
Review
Axillary web syndrome (AWS) is defined as a visible and palpable network of cords in the skin of the axillary cavity that are tensed by shoulder abduction following surgery for breast cancer, causing significant functional limits of the ipsilateral upper limb (UL) and pain. The purpose of this narrative review is to discuss rehabilitation approaches for greater efficacy with respect to pain and novel suggestions. AWS is a frequent complication of axillary lymphadenectomy that necessitates a thorough follow-up in the medium to long term. Physiotherapy is effective in the treatment of functional limb deficits, the management of pain, and the treatment of upper limb disability. The best management approach involves the use of soft tissue techniques to slow the natural course of the syndrome, in association with therapeutic exercises for functional recovery and muscle strengthening. AWS is linked secondary lymphedema, requiring integration with manual lymphatic drainage. The physiotherapy management of AWS is currently fragmented, and insufficient information is available on the nature of the disease. Thus, randomized and controlled studies that compare rehabilitation approaches in AWS are desirable, including the possibility of using mesotherapy in the treatment of axillary and upper limb pain.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymphedema; Pain; Postoperative Complications
PubMed: 34639683
DOI: 10.3390/ijerph181910383 -
VASA. Zeitschrift Fur Gefasskrankheiten Nov 2023To compare the effectiveness of intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance...
To compare the effectiveness of intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance treatment of lymphedema. Patients in the maintenance phase of lymphedema therapy with MLD and compression since more than a year with stable values for weight and circumferences of ankle and calf were asked to participate in a study: Compression had to be worn daily, (1) 4 weeks IPC+MLD, (2) 4 weeks MLD alone, (3) 4 Weeks IPC alone (Order 1 and 3 was randomized). At the beginning and after each 4 weeks, circumference measurements (by hand and by machine: BT600, Bauerfeind) were documented, pain and discomfort were assessed, and quality-of-life questionnaires were completed. Of 20 participants, 18 (14 female, 4 male), mean age 59.6 years (48-89) could be evaluated. 11 subjects had bilateral, 7 unilateral, 5 primary, 13 secondary lymphedema since 2-20 years (mean 7.7), the subjects had received MLD and compression for 2-14 years (mean 6.4), 1-3 times per week (mean 1.5). The BMI ranged between 21 and 47 (mean 33.7). No differences between any phases were found for: Calf and thigh volume, circumference of calf. Only the ankle circumference was significant less (-0.22 cm) when using "both" (IPC+MLD). Compared to before the study, quality of life was better in all three phases, but with a significantly higher improvement in the phases with IPC than in the phases without. There were no differences in objective measurement between MLD alone, IPC alone or both, excepting the minimal significant difference in ankle circumference after IPC+MLD. QOL favored IPC application. Considering the economic consequences of these results, a change of maintenance therapy with MLD weekly over years in favor of permanent care with IPC and few appointments of MLD per year should be considered and further investigated.
Topics: Humans; Male; Female; Middle Aged; Manual Lymphatic Drainage; Quality of Life; Intermittent Pneumatic Compression Devices; Lymphedema; Pressure; Treatment Outcome
PubMed: 37840280
DOI: 10.1024/0301-1526/a001090 -
PLoS Neglected Tropical Diseases Jun 2016Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a... (Review)
Review
BACKGROUND
Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema.
METHODOLOGY/PRINCIPAL FINDINGS
Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured.
CONCLUSIONS/SIGNIFICANCE
There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people with CR-LE. Empowerment of people with lymphedema to care for themselves with access to supportive professional assistance has the capacity to optimise self-management practices and improve outcomes from limited health resources.
Topics: Elephantiasis, Filarial; Humans; Lymphedema; Neoplasms; Self Care
PubMed: 27275844
DOI: 10.1371/journal.pntd.0004740 -
Journal of Reconstructive Microsurgery Mar 2022Lymphatic vessels are difficult to identify using existing modalities as because of their small diameter and the transparency of the lymph fluid flowing through them.
BACKGROUND
Lymphatic vessels are difficult to identify using existing modalities as because of their small diameter and the transparency of the lymph fluid flowing through them.
METHODS
Here, we introduce photoacoustic lymphangiography (PAL), a new modality widely used for lymphedema treatment, to observe limb lymphatic vessels. The photoacoustic imaging system used in this study can simultaneously visualize lymphatic vessels and veins with a high resolution (0.2 mm) and can also observe their three-dimensional relationship with each other.
RESULTS
High-resolution images of the lymphatic vessels, detailed structure of the dermal back flow, and the three-dimensional positional relationship between the lymphatic vessels and veins were observed by PAL.
CONCLUSION
The clear image provided by PAL could have a major application in pre- and postoperative use during lymphaticovenular anastomosis for lymphedema treatment.
Topics: Anastomosis, Surgical; Humans; Lymphatic Vessels; Lymphedema; Lymphography; Photoacoustic Techniques
PubMed: 34959248
DOI: 10.1055/s-0041-1736518 -
Anais Brasileiros de Dermatologia 2015Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb extremities. Rare, it occurs in 0.5% of patients who have undergone radical...
Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb extremities. Rare, it occurs in 0.5% of patients who have undergone radical mastectomy with axillary node dissection. The main cause is chronic lymphedema with endothelial and lymphatic differentiation, with no direct relationship to breast cancer. Seven years after a radical right-side mastectomy with lymph node dissection and adjuvant therapy, the patient developed a lesion on her right arm. The dermatological examination revealed an erythematous nodule with bleeding surface on chronic right forearm lymphedema. After the biopsy, a lymphangiosarcoma on chronic lymphedema was diagnosed. Infrequent, this syndrome is relevant because of its associated mortality. Early diagnosis is important to improve survival and reduce complications.
Topics: Aged; Amputation, Surgical; Arm; Biopsy; Female; Hemangiosarcoma; Humans; Lymphangiosarcoma; Lymphedema; Mastectomy; Neoplasm Recurrence, Local; Skin Neoplasms
PubMed: 26312725
DOI: 10.1590/abd1806-4841.20153685 -
Integrative Cancer Therapies 2023The objective of this study is to evaluate the effect of Tuina combined with moxibustion on relieving breast cancer-related lymphedema (BCRL). A randomized cross-over... (Randomized Controlled Trial)
Randomized Controlled Trial
The objective of this study is to evaluate the effect of Tuina combined with moxibustion on relieving breast cancer-related lymphedema (BCRL). A randomized cross-over controlled trial was conducted at our institution. All patients with BCRL were assigned to 2 groups: Group A and Group B. In the first period (weeks 1-4), tuina and moxibustion were performed in Group A and pneumatic circulation and compression garment in Group B. The washout period took place from weeks 5 to 6. In the second period (weeks 7-10), pneumatic circulation and compression garment were performed in Group A, and tuina and moxibustion in Group B. Therapeutic efficacy was evaluated by measuring the affected arm volume, circumference, and Visual Analog Scale for swelling. Regarding the results, a total of 40 patients were included, and 5 cases were dropped. After treatment, both the traditional Chinses medicine (TCM) treatment and complete decongestive therapy (CDT) was found to reduce the volume of the affected arm ( < .05). At the endpoint (visit 3), compared with CDT, the effect of the TCM treatment was more evident than that of CDT ( < .05). After the TCM treatment, the arm circumference at the elbow crease and proximal 10 cm to elbow crease was reduced, which was statistically different from that before treatment ( < .05). Post-CDT treatment, the arm circumference at proximal 10 cm to wrist crease and the elbow crease and proximal 10 cm to elbow crease decreased, which was statistically different from that before treatment ( < .05). At the endpoint (visit 3), the arm circumference at proximal 10 cm to elbow crease of the patients treated with TCM was less than that of CDT ( < .05). Moreover, the VAS scores for swelling were better after compared with before TCM treatment and CDT ( < .05). At the endpoint (visit 3), the subjective relief of swelling by TCM treatment was greater than CDT ( < .05). Ultimately, tuina combined with moxibustion can alleviate BCRL symptoms, which is primarily reflected in reducing the affected arm volume and circumference and relieving swelling.Trial registration: Chinese Clinical Trial Registry (Registration Number ChiCTR1800016498).
Topics: Humans; Female; Moxibustion; Breast Neoplasms; Treatment Outcome; Breast Cancer Lymphedema; Upper Extremity; Lymphedema
PubMed: 37212216
DOI: 10.1177/15347354231172735 -
Journal of Cancer Survivorship :... Dec 2023Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This... (Review)
Review
PURPOSE
Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures.
METHOD
Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence.
RESULTS
Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast).
CONCLUSIONS
Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures.
IMPLICATIONS FOR CANCER SURVIVORS
There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.
Topics: Humans; Female; Breast Neoplasms; Reproducibility of Results; Patient Reported Outcome Measures; Cancer Survivors; Lymphedema; Psychometrics
PubMed: 36301407
DOI: 10.1007/s11764-022-01278-w