Abstract
Background
Breast-cancer-related lymphoedema, either caused by the tumour itself or its therapy, can be found in approximately 24% of all patients. It results in disabilities, psychological distress and reduced quality of life. Therefore, proper therapy for this entity is very important. Guidelines recommend a therapy in two phases, an intensive phase I for 3 weeks for volume reduction and, between the cycles of phase I, a reduced phase II to maintain the result. During phase I therapy, manual lymphatic drainage often cannot be administered on weekends or holidays; only a reduced therapy, mainly by application of a more or less passive compression by bandaging, is administered. For this, conventional low-stretch bandages are hitherto being used. Several attempts have been made to overcome this disadvantage by either impregnating or covering the bandage with sticky or adhesive substances such as india rubber, elastomeres, polyacrylates, etc. Recently, new bandages are available, which are drenched with alginate that becomes semi-rigid after drying for approximately 6 h. It was the aim of this study to compare alginate bandaging to a conventional lymphologic-multilayered low-stretch bandaging with individual supportive lining as to their effect concerning their congestive capacity in exactly delimited time periods of reduced decongestive therapy as well as the patients’ tolerance.
Materials and methods
From December 2007 until May 2008, 61 female patients with a one-sided lymphoedema of the axillary tributary region after axillar dissection who underwent a phase I complex decongestive therapy were prospectively selected for our investigation. On weekends, group A got the conventional low-stretch compressive bandaging, whereas group B got an alginate semi-rigid bandage. Arm volumes were measured before and after these bandages were applied. Additionally, the subjective sensations of the skin caused by the compression were measured by means of a five-level Likert scale.
Results and conclusions
The initial volumes (V 0) of the two groups (A, 2,939.0 ml ± 569.182; B, 3,062.6 ml ± 539.161) varied within the same magnitude, with somewhat smaller values in group A. The same was true for the final volumes (V 6), measured at day 22 (A, 2,674.5 ml ± 480.427; B, 2,740.1 ml ± 503.593). During the weekends, the arm volumes re-increased (first weekend: A, 16.4 ml vs. B, 4.7 ml; second weekend: A, 14.2 ml vs. B, 2.7 ml; third weekend: A, 7.5 ml vs. B, 1.1 ml). A significantly smaller volume increase appeared in the alginate group during the weekends. There were no serious side effects in both groups. Concerning the patients’ comfort, the values of the alginate group were clearly better than those of the conventionally bandaged group. Additionally, the volume changes in the alginate group revealed fewer fluctuations. As a summary, one can state that a good alternative to the conventional bandaging is available with the alginate bandages, bringing distinct advantages for the patients when administered properly.
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References
Lerner R, Requena R (1986) Upper extremity lymphedema secondary to mammary cancer treatment. Am J Clin Oncol 9:481–487. doi:10.1097/00000421-198612000-00004
Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G (2001) Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer 92:1783–1787. doi:10.1002/1097-0142(20011001)92:7<1783::AID-CNCR1694>3.0.CO;2-G
Neuhüttler S, Kröll A, Brenner E (2006) Ätiologie sekundärer Lymphödeme onkologischer Genese. Phlebologie 35:117–126
Pyszel A, Malyszezak K, Pyszel K, Andrzejak R, Szuba A (2006) Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology 39:185–192
Schreiber H, Barry FM, Russell WC, WLt M, Ponsky JL, Pories WJ (1979) Stewart–Treves syndrome. A lethal complication of postmastectomy lymphedema and regional immune deficiency. Arch Surg 114:82–85
Döller W, Apich G (2003) Stewart-Treves-Syndrom bei chronischem Armlymphödem nach radikaler Mastektomie. Ein Fallbericht LymphForsch 7:81–83
Hutzschenreuter PO, Wittlinger H, Wittlinger G, Kurz I (1991) Post-mastectomy arm lymphoedema: treated by manual lymph drainage and compression bandage therapy. Arch Phys Med Rehabil 1:166
Casley-Smith JR, Boris M, Weindorf S, Lasinski B (1998) Treatment for lymphedema of the arm—the Casley–Smith method: a noninvasive method produces continued reduction. Cancer 83:2843–2860. doi:10.1002/(SICI)1097-0142(19981215)83:12B+<2843::AID-CNCR38>3.0.CO;2-U
Dini D, Del Mastro L, Gozza A, Lionetto R, Garrone O, Forno G, Vidili G, Bertelli G, Venturini M (1998) The role of pneumatic compression in the treatment of postmastectomy lymphedema. A randomized phase III study. Ann Oncol 9:187–190. doi:10.1023/A:1008259505511
Kasseroller RG, Schrauzer GN (2000) Treatment of secondary lymphedema of the arm with physical decongestive therapy and sodium selenite: a review. Am J Ther 7:273–279. doi:10.1097/00045391-200007040-00008
Szuba A, Strauss W, Sirsikar SP, Rockson SG (2002) Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity. Nucl Med Commun 23:1171–1175. doi:10.1097/00006231-200212000-00004
Werner T, Reißhauer A (1998) Deutsche Gesellschaft für Physikalische Medizin und Rehabilitation: Leitlinie: Behandlung des Lymphödems (e-book).
ISL (2003) The diagnosis and treatment of peripheral lymphedema. Lymphology 36:84–91
Seifart U, Albert US, Heim ME, Hübner J, Jungkunz W, Prokein R, Rick O, Hoffmann M, Engenhart-Cabillic R, Kopp I, Wagner U, Kalder M (2007) Lymphödem bei Mammakarzinom - Konsensus zur Sektoren-übergreifenden Diagnostik und Therapie des postoperativen Lymphödems bei Patientinnen mit primärem Mammakarzinom. Rehabilitation 46:340–348. doi:10.1055/s-2007-985170
Ko DSC, Lerner R, Klose G, Cosimi AB (1998) Effective treatment of lymphedema of the extremities. Arch Surg 133:452–458. doi:10.1001/archsurg.133.4.452
Földi M, Kubik S (2002) Lehrbuch der Lymphologie für Mediziner und Physiotherapeuten. Urban & Fischer, Stuttgart
Kasseroller R, Brenner E (2007) Kompendium der Lymphangiologie: Manuelle Lymphdrainage - Kompression - Bewegungstherapie. Thieme, Stuttgart
Partsch H, Rabe E, Stemmer R (1999) Kompressionstherapie der Extremitäten. Editions Phlébologiques Françaises, Paris
Morris MD (1995) Gesundheitliche Aspekte von synthetischen Austauschmaterialien für Naturlatex. Gummi, Fasern, Kunststoffe 48:542–545
Reines HD, Seifert PC (2005) Patient safety: latex allergy. Surg Clin North Am 85:1329–1340. doi:10.1016/j.suc.2005.09.014
Forner-Cordero I, Navarro-Monsoliu R, Munoz-Langa J, Alcober-Fuster P, Rel-Monzo P (2007) Use of a nanocrystalline silver dressing on lymphatic ulcers in patients with chronic lymphoedema. J Wound Care 16:235–239
Jude EB, Apelqvist J, Spraul M, Martini J (2007) Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med 24:280–288. doi:10.1111/j.1464-5491.2007.02079.x
Kasseroller R (2005) LVF - Lymphödemklassifikation des inguinalen und axillären Tributargebietes. Z Gefassmedizin 2:4–8
Herpertz U (2003) Apparative intermittierende Kompression: Ein Plädoyer für den gezielten Einsatz von Kompressionsgeräten. LymphForsch 7:30–31
Kuhnke E (1976) Volumenbestimmung aus Umfangmessung. Folia Angiol 26:228–232
Marshall M, Breu FX (1999) Differential diagnosis of lymphedema, lipedema, and phlebedema using high-resolution (duplex) ultrasound. Phlebolymphology 25:25–32
Brenner E (2005) Das Lymphödem im Ultraschall—ein Literaturreview. Phlebologie 34:143–145
Marshall M (2005) Duplex-sonographische Kriterien für Lymph- u. Lipödeme. Phlebologie 34:325–326
Acknowledgement
We gratefully thank Mrs. Claudia Siemon for her valuable assistance in language editing our manuscript.
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Conception and study design was carried out by RK, data collection by RK, analysis and data interpretation by RK and EB, manuscript preparation by RK and EB and literature search by RK and EB.
The authors have no competing interests to declare.
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Kasseroller, R.G., Brenner, E. A prospective randomised study of alginate-drenched low stretch bandages as an alternative to conventional lymphologic compression bandaging. Support Care Cancer 18, 343–350 (2010). https://doi.org/10.1007/s00520-009-0658-7
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DOI: https://doi.org/10.1007/s00520-009-0658-7