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Liposuction and Controlled Compression Therapy in the Treatment of Arm Lymphedema following Breast Cancer

Brorson, Håkan LU (1998) In Lund University Dissertations
Abstract (Swedish)
Popular Abstract in Swedish

Liposuction och kontrollerad kompressionsbehandling av armlymfödem efter bröstcancerbehandling



Behandlingen av bröstcancer är kirurgisk. Förutom att bröstet avlägsnas innefattar behandlingen ofta borttagning av lymfkörtlar i armhålan samt strålbehandling. Detta leder till att flödet av lymfa från armen kraftigt försämras med svullnad som följd (lymfödem). Detta inträffar i c:a 25% av fallen. Cancern i sig utgör ett orosmoment, men den svullna och tunga armen adderar ytterligare handikapp både ur fysisk och psykosocial synpunkt. Tidigare kirurgiska och icke- kirurgiska (konservativa) behandlingsmetoder har inte alltid givit tillfredsstäl-lande och varaktiga resultat, sannolikt... (More)
Popular Abstract in Swedish

Liposuction och kontrollerad kompressionsbehandling av armlymfödem efter bröstcancerbehandling



Behandlingen av bröstcancer är kirurgisk. Förutom att bröstet avlägsnas innefattar behandlingen ofta borttagning av lymfkörtlar i armhålan samt strålbehandling. Detta leder till att flödet av lymfa från armen kraftigt försämras med svullnad som följd (lymfödem). Detta inträffar i c:a 25% av fallen. Cancern i sig utgör ett orosmoment, men den svullna och tunga armen adderar ytterligare handikapp både ur fysisk och psykosocial synpunkt. Tidigare kirurgiska och icke- kirurgiska (konservativa) behandlingsmetoder har inte alltid givit tillfredsstäl-lande och varaktiga resultat, sannolikt p.g.a. att lymfödemet orsakar en tillväxt av underhudsfettet och på sikt en förhårdnad av vävnaden (fibros). I detta perspektiv är operation med fettsugning (liposuction, LS) kombinerad med kontrollerad kompressionsbehandling med en elastisk armstrumpa (Controlled Compression Therapy, CCT) en intressant ny metod. Därigenom avlägsnas den förtjockade fett- vävnaden effektivt, och resultatet vidmakthålls med kompressions-strumpan. Totalt har 51 kvinnor deltagit i studierna. Samtliga patienter utom en hade strålbehandlats efter bröstcanceroperationen, som också omfattade borttagning av lymfkörtlar i armhålan i samtliga fall. 36 patienter behandlades med LS följd av CCT, och 15 med enbart CCT. Hos 6 opererade patienter avlägsnades kompressionsstrumpan under en vecka efter ett år. Mätning av ödemvolymen skedde genom att den svullna respektive friska armen sänktes ned i en behållare med vatten. Skillnaden mellan de undanträngda vätskevolymerna blir därigenom ett mått på ödem-volymen. Hudblodflödet registrerades med laser Doppler bildanalys (laser Doppler imaging, LDI). Metoden bygger på att ljus av en våg-längd får ett breddat spektrum om det reflekteras av hudkärlens blod-kroppar i rörelse. Lymfflödet registrerades med s.k. indirekt lymf- scintigrafi (ILS). Metoden innebär att en radioaktiv substans sprutas in under huden i handen och dess transport längs armens lymfsystem följes genom substansens spontana strålavgivning. Rörligheten i axelleden mättes med gradskiva. Effekter på livskvalitén uppskattades med väl etablerade metoder. "Visuell analogskala" användes för att avspegla grad av smärta, handsvullnad och problem med vardagliga aktiviteter. "Nottingham Health Profile" och "Psychological General Well-Being index" utnyttjades för mätning av upplevelser av olika hälsorelaterade problem. "Hospital Anxiety Depression Scale" användes som ett mått på graden av oro och nedstämdhet. Samtliga parametrar registrerades före behandling och upp till ett år därefter. LS+CCT avlägsnade armlymfödemet fullständigt, jämfört med en reduktion på 50% med enbart CCT. Användande av kompressions-strumpa är en förutsättning för att vidmakthålla behandlingseffekten. LS+CCT försämrade inte den redan nedsatta lymftransporten och förbättrade snarast hudcirkulationen. Sannolikt som en följd av detta registrerades en minskad förekomst av rosfeber i armen. Behandling med LS+CCT samt enbart CCT förbättrade axelrörlighet och livskvalité, speciellt i sådana avseenden som direkt kunde hänföras till ödemminskningen såsom smärta, svullnad, tyngdkänsla och trötthet/svaghet, varigenom vardagliga aktiviteter underlättades. Som kunde förväntas av ödemreduktionerna sågs de bästa resultaten i LS+CCT gruppen. (Less)
Abstract
Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer



About one-third of all women treated for breast cancer develop arm lymphedema. The cancer itself is a worry, but the swollen and heavy arm is an additional handicap for the patients, both physical and psychosocial. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a... (More)
Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer



About one-third of all women treated for breast cancer develop arm lymphedema. The cancer itself is a worry, but the swollen and heavy arm is an additional handicap for the patients, both physical and psychosocial. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Altogether 51 women participated in the present investigations. All, except one had received radiotherapy after the breast cancer operation which included the excision of axillary lymphnodes in all cases. Thirty-six patients were treated with LS and postoperative CCT, whereas 15 received CCT only. Pre- and postoperative arm edema volumes were measured using water displacement technique. Skin blood flow was recorded using laser Doppler imaging. Lymph transport in the arm was assessed with indirect lymphoscintigraphy. Rage of motion in the shoulder joint was measured using a protractor. Effects on quality of life were estimated using the Visual Analogue Scale, Nottingham Health Profile, Psychological General Well-Being index, and the Hospital Anxiety Depression scale. Results were monitored for up to one year after treatment. LS+CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary to maintain the normalized arm volume. LS+CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted. The treatment improved range of motion in the shoulder joint and patients' quality of life, particularly qualities directly related to the volume reduction and thereby qualities associated with everyday activities. As could be expected from the volume measurements, the more favorable outcomes were recorded mostly in the LS+CCT group. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor, MD Witte, Charles L., Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
organization
publishing date
type
Thesis
publication status
published
subject
keywords
quality of life, Surgery, orthopaedics, traumatology, ortopedi, Kirurgi, traumatologi, arm lymphedema, arm lymphoedema, Psychological General Well-Being index, Hospital Anxiety and Depression Scale, shoulder mobility, Nottingham Health Profile, VAS, lymphoscintigraphy, laser Doppler imaging, skin blood flow, controlled compression therapy, breast cancer, liposuction
in
Lund University Dissertations
pages
160 pages
publisher
Surgery Research Unit, Dept of Plastic and Reconstructive Surgery, Malmö University Hospital, SE-205 02 Malmö, Sweden,
defense location
Lecture Hall, Entrance 35, Malmö University Hospital, Malmö, Sweden
defense date
1998-11-14 10:15
external identifiers
  • Other:ISRN: LUMEDW/MESM-1072-SE
ISBN
91-628-3206-9
language
English
LU publication?
yes
id
fff7eadf-ddf3-4278-accc-375f02382c13 (old id 38993)
date added to LUP
2007-06-20 12:17:02
date last changed
2016-09-19 08:45:12
@misc{fff7eadf-ddf3-4278-accc-375f02382c13,
  abstract     = {Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer<br/><br>
<br/><br>
About one-third of all women treated for breast cancer develop arm lymphedema. The cancer itself is a worry, but the swollen and heavy arm is an additional handicap for the patients, both physical and psychosocial. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Altogether 51 women participated in the present investigations. All, except one had received radiotherapy after the breast cancer operation which included the excision of axillary lymphnodes in all cases. Thirty-six patients were treated with LS and postoperative CCT, whereas 15 received CCT only. Pre- and postoperative arm edema volumes were measured using water displacement technique. Skin blood flow was recorded using laser Doppler imaging. Lymph transport in the arm was assessed with indirect lymphoscintigraphy. Rage of motion in the shoulder joint was measured using a protractor. Effects on quality of life were estimated using the Visual Analogue Scale, Nottingham Health Profile, Psychological General Well-Being index, and the Hospital Anxiety Depression scale. Results were monitored for up to one year after treatment. LS+CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary to maintain the normalized arm volume. LS+CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted. The treatment improved range of motion in the shoulder joint and patients' quality of life, particularly qualities directly related to the volume reduction and thereby qualities associated with everyday activities. As could be expected from the volume measurements, the more favorable outcomes were recorded mostly in the LS+CCT group.},
  author       = {Brorson, Håkan},
  isbn         = {91-628-3206-9},
  keyword      = {quality of life,Surgery,orthopaedics,traumatology,ortopedi,Kirurgi,traumatologi,arm lymphedema,arm lymphoedema,Psychological General Well-Being index,Hospital Anxiety and Depression Scale,shoulder mobility,Nottingham Health Profile,VAS,lymphoscintigraphy,laser Doppler imaging,skin blood flow,controlled compression therapy,breast cancer,liposuction},
  language     = {eng},
  pages        = {160},
  publisher    = {ARRAY(0x9dc8730)},
  series       = {Lund University Dissertations},
  title        = {Liposuction and Controlled Compression Therapy in the Treatment of Arm Lymphedema following Breast Cancer},
  year         = {1998},
}