• Medical Lasers
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• v.10 no.4
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• pp.189-194
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• 2021

Breast cancer-related lymphedema (BCRL) is characterized by the persistent accumulation of interstitial fluid in the peripheral tissues after treatment for breast cancer. Photobiomodulation (PBM) therapy is widely used as supportive care for patients with BCRL. A search was performed in the PubMed database to find relevant articles published over the last 20 years. Randomized controlled trials that evaluated the efficacy of PBM therapy on BCRL were included. A total of 24 studies were identified through the PubMed database. Seven studies were used for the final analysis, after excluding items that did not meet the duplication and inclusion criteria. Although PBM showed some improvement in reducing arm circumference and the symptoms related to BCRL, the results of the meta-analysis did not show any significant benefit in alleviating lymphedema. Further studies are needed with the recruitment of more participants to evaluate the long-term efficacy and safety of PBM in the management of BCRL.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.899-902
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• 2011

Purpose: Lymphedema of the scrotum and penis is a functionally and emotionally incapacitating problem for patients. Patients suffer pain from swelling, chronic irritation, repeated infections, drainage, and sexual dysfunction. Although there are various methods for the treatment of scrotal and penial lymphedema, achieving a satisfactory reconstruction in severe cases still remains a challenge due to the lack of locally available tissue. Methods: A 33-year-old man sustained severe lymphedema of the scrotum and penis. He reported a history of swelling since 25 years, which had been intensified during the past few months. There was no history of irritation, surgery, trauma, infection or travel to endemic countries. The authors reconstructed the scrotum and penis using 4 scrotal flaps made by incising the enlarged scrotum crucially. Results: The postoperative course was uneventful. Histopathologic examination showed nonspecific chronic inflammation. The patient was followed up for 18 months and a good reconstructive result was obtained with no recurrence. Conclusion: The authors' method is safe and easy to perform. This method may be a convenient and reliable alternative for the treatment of severe lymphedema of the scrotum and penis.

• Journal of Korean Physical Therapy Science
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• v.5 no.2
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• pp.595-602
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• 1998

The purpose of this study was to investigate the effect of sequential intermittent pneumatic compression in patients with lymphedema who were hospitalized for three days at Samsung Medical Center. Thirty-three subjects with lymphedema was selected by physician referral. A selection of the patients was made according to the following criteria : 1) no known metastases, 2) no infection after the a difference of at least 10% in the volumes of edematous limb. All patients were treated with the Lympha-Press(Model 103-A). Circumferential limb mesurements was done before and after a 3-day treatment period. As a result of sequential intermittent pneumatic compression therapy. All extremity showed a decrease in circumferential measurements with the maximal reduction occurring at the wrist(55.75 %) for the upper extremities and at the lower 1/3 of calf (40.61%) for the lower extremities. Upper extremity arm was reduced by 42.1% and lower extremity leg by 33.61%. In contrast with this, the proximal levels of arm patients and leg showed comparatively poor reduction than distal levels. Almost 44.44% of arm patients and 5.26% of leg patients experienced significant reduction(> 50%) after compression therapy. These data clearly indicates that Sequential Intermittent Pneumatic Compression Therapy was effective treatment for reducing of extremity volume in patients with lymphedema. but this was variable degree and dependent on the amount of pre-existing lymphedema. Other factors such as duration of edema, etiology, previous history of radiology, age did not appear to influence the extend of improvement. Further sutdies will be necessary to determine long term benefit of this therapy.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.305-309
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• 2020

Breast cancer treatment-related lymphedema (BCRL) is a common comorbidity in breast cancer survivors. Although magnetic resonance imaging (MRI) is widely used to evaluate therapeutic response of patients with various medical conditions, it is not routinely used to evaluate lymphedema patients. We conducted a systematic review of the literature to identify studies on the use of MRI to evaluate therapy for BCRL. We hypothesized that MRI could provide information otherwise not possible through other examinations. On October 21, 2019, we conducted a systematic review on the PubMed/MEDLINE and Scopus databases, without time frame or language limitations, to identify studies on the use of MRI to evaluate therapy for BCRL. We excluded studies that investigated other applications of MRI, such as lymphedema diagnosis and surgical planning. Of 63 potential articles identified with the search, three case series fulfilled the eligibility criteria. In total, 53 patients with BCRL were included and quantitatively evaluated with MRI before and after manual lymphatic drainage. Authors used MRI or MR lymphagiography to investigate factors such as lymphatic vessel cross-sectional area, tissue water relaxation time (T₂), and chemical exchange saturation transfer. The only study that compared MRI measurement with standard examinations reported that MRI added information to the therapy evaluation. MRI seems to be a promising tool for quantitative measurement of therapeutic response in patients with BCRL. However, the identified studies focused on only manual lymphatic drainage and were limited by the small numbers of patients. More studies are necessary to shed light on the topic.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.588-593
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• 2014

Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and postoperative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was $7.2{\pm}0.5$, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of $8.5{\pm}0.7$ and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.15 no.2
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• pp.8-14
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• 2009

Purpose: to apply lymph massage to the patients that contracted lymphedema after mastectomy to resolve blood congestion, stimulate circulation, and control swelling long-term. Methods: The subjects include 20 female patients that were diagnosed with breast cancer histologically and contracted lymphedema within one to two years after mastectomy. They received lymph massage from March to August, 2008. Using a measuring tape(capable of measuring mm), the arm circumference was measured in both the sick and normal arm. Only the data from the sick arm were compared before and after the treatment. The measuring points were five; the back of the hand(a certain distance[about 10cm] was set between the end of the middle finger to the center of the palm), the wrist(the smallest section), the lower arm(at a certain distance[about 10cm] from the internal bending part of the elbow), the elbow(the bending part), and the upper arm(at a certain distance[about 10cm] from the internal bending part of the elbow). Collected data were analyzed using the SPSS/WINDOWS Version 12.0 program. Results: There was a reduction of lymphedema observed in all the points including 10cm in the upper arm, the elbow, 10cm in the lower arm, the wrist and the back of the hand after lymph massage, and the reduction had statistically significant differences(p<.05). Conclusion: Those results indicate that lymph massage has effects on the reduction of lymphedema in the early patients that contracted it after mastectomy.

• Archives of Plastic Surgery
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• v.48 no.5
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• pp.559-567
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• 2021

The potential to differentiate into different cell lines, added to the easy and cost-effective method of extraction, makes adipose-derived stem cells (ADSCs) an object of interest in lymphedema treatment. Our study's goal was to conduct a comprehensive systematic review of the use of ADSCs in lymphatic tissue engineering and regeneration. On July 23, 2019, using PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, and Embase databases, we conducted a systematic review of published literature on the use of ADSCs in lymphatic tissue engineering and regeneration. There were no language or time frame limitations, and the following search strategy was applied: ((Adipose stem cell) OR Adipose-derived stem cell)) AND ((Lymphedema) OR Breast Cancer Lymphedema). Only original research manuscripts were included. Fourteen studies fulfilled the inclusion criteria. Eleven studies were experimental (in vitro or in vivo in animals), and only three were clinical. Publications on the topic demonstrated that ADSCs promote lymphangiogenesis, and its effect could be enhanced by modulation of vascular endothelial growth factor-C, interleukin-7, prospero homeobox protein 1, and transforming growth factor-β1. Pilot clinical studies included 11 patients with breast cancer-related lymphedema, and no significant side effects were present at 12-month follow-up. Literature on the use of ADSCs in lymphatic tissue engineering and regeneration demonstrated promising data. Clinical evidence is still in its infancy, but the scientific community agrees that ADSCs can be useful in regenerative lymphangiogenesis. Data collected in this review indicate that unprecedented advances in lymphedema treatment can be anticipated in the upcoming years.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.2
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• pp.15-24
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• 2021

Objectives Purpose of our study is to investigate the preventive and therapeutic effect of Chuna manual therapy (CMT) for lymphedema. Methods A study search of 10 databases was performed. We included the randomized controlled trials (RCTs) which performed CMT for lymphedema in this study. The keywords used were 'chuna' or 'tuina' and 'lymphedema'. Two independent authors rated study quality and risk of bias using the Cochrane risk of bias tool. Results 9 appropriate RCTs were remained after screening. The therapeutic effects of the experimental group was statistically higher than that of the control group with functional exercise or taking western medicine. Subjective symptom score was also lower in the CMT group. Conclusions These results suggests that CMT has sufficient evidence that it is more effective in prevent or alleviating symptoms of lymphedema than conventional treating methods. However, due to the high risk of bias of included studies, further researches are needed with higher quality of evidence.

• Archives of Plastic Surgery
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• v.49 no.1
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• pp.99-107
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• 2022

Background Dermal backflow (DBF), which refers to lymphatic reflux due to lymphatic valve insufficiency, is a diagnostic finding in lymphedema. However, the three-dimensional structure of DBF remains unknown. Photoacoustic lymphangiography (PAL) is a new technique that enables the visualization of the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and can provide three-dimensional images of superficial lymphatic vessels and the venous system. This study reports the use of PAL to visualize DBF structures in the extremities of patients with lymphedema after cancer surgery. Methods Patients with a clinical or lymphographic diagnosis of lymphedema who previously underwent surgery for cancer at one of two participating hospitals were included in this study. PAL was performed using the PAI-05 system. ICG was administered subcutaneously in the affected hand or foot, and ICG fluorescence lymphography was performed using a near-infrared camera system prior to PAL. Results Between April 2018 and January 2019, 21 patients were enrolled and examined using PAL. The DBF was composed of dense, interconnecting, three-dimensional lymphatic vessels. It was classified into three patterns according to the composition of the lymphatic vessels: a linear structure of lymphatic collectors (pattern 1), a network of lymphatic capillaries and lymphatic collectors in an underlying layer (pattern 2), and lymphatic capillaries and precollectors with no lymphatic collectors (pattern 3). Conclusions PAL showed the structure of DBF more precisely than ICG fluorescence lymphography. The use of PAL to visualize DBF assists in understanding the pathophysiology and assessing the severity of cancer-related lymphedema.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.4
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• pp.113-120
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• 2022

Purpose : Lymphedema is a common complication in mastectomy patients and is usually characterized by pain, swelling, and limited range of motion (ROM) in the arm. Electromyostimulation (EMS) is widely used for the rehabilitation and recovery of subjects with various neuromusculoskeletal disorders after breast cancer. However, EMS has not yet been used in many Pilates exercises. This study was aimed at comparing the effects of instrument Pilates integrated with EMS on pain, lymphedema, and ROM of the upper extremity (UE) in breast cancer subjects after mastectomy. Methods : Nine female breast cancer subjects who had undergone mastectomy participated in the study. The subjects underwent instrument Pilates with EMS (experimental group) or instrument Pilates only (control group). Pain, lymphedema, and ROM of the UE were measured using the visual analog scale (VAS), the circumference length of the UE, and the ROM of the UE. The Wilcoxon signed-rank test was used to compare the pain, lymphedema, and ROM of the arm before and after the intervention, and the Mann-Whitney U test was used to compare the two groups. The statistical significance level was set to p < .05. Results : In the experimental group, there were significant differences in pain (p<.05) and UE circumference (p<.05) before and after intervention. However, there was no significant difference between the two groups in VAS (p>.05) or circumference length of the UE (p>.05). There was one significant difference between the groups in terms of internal rotation of the ROM of the UE (p<.05). Conclusion : These results show that instrument Pilates exercises combined with EMS may positively affect the internal rotation of the ROM of the UE in breast cancer patients after mastectomy, thus contributing to existing knowledge about instrument Pilates using EMS for the effective management of in breast cancer subjects after mastectomy.