• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.73-84
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• 2022

Background : Lymphedema is a progressive disorder characterized by the impairment of lymph flow from tissues to the blood circulation system. This occurs as a result of damage to the lymphatic system. Complex decongestive therapy (CDT) is a multimodal, conservative therapeutic approach that is used for the management of lymphedema. CDT consists of a combination of compression therapy, manual lymphatic drainage, exercise, and skin care. Purpose : This study aimed to provide a review of available physical therapy interventions as well as general care guidelines for patients with lymphedema. Methods : The recommendations and guidelines for physical therapy management, medical management, and general information were reviewed from the following sources: 1) The American Physical Therapy Association, 2) The Norton School of Lymphatic Therapy, and 3) The International Society of Lymphology. This review contains general information, including the medical management and the importance of physical therapy in lymphedema. Physical therapy management should be based on an assessment of the patients' presenting impairments, including based on inclusion or exclusion of physical therapy interventions. This review also outlines a step-by-step approach that starts with disease diagnosis and progression all the way through to rehabilitation as an outpatient. Conclusion : Depending on the patients' journey to recovery and the requirement for rehabilitation, physical therapy interventions should focus on the patients' needs including pain, appearance, physical function and general rehabilitation. We hope that this review will provide information on evidence-based physical therapy and general care to patients with lymphedema.

• Journal of The Korean Society of Integrative Medicine
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• v.12 no.3
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• pp.101-120
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• 2024

Purpose : This study aimed to carry out a scoping review to investigate the research trends in non-pharmacological interventions for physical rehabilitation following breast cancer treatment. Methods : A scoping review was conducted according to the five steps outlined by Arksey and O'Malley and PRISMA-ScR. We searched three domestic databases (ScienceOn, Riss, KCI) and two international databases (PubMed, Cochrane Central) between January 2014 and April 2024. The keywords used were 'breast cancer surgery', 'breast cancer treatment', 'breast cancer lymphedema', 'intervention', 'management', 'therapy', 'disorder', and 'dysfunction'. Results : In terms of publication, the number of studies in the past five years has increased compared to the previous five years, with most studies focusing on patients aged 41 to 60 and who underwent surgical treatment for breast cancer. A total of 43 different types of non-pharmacological interventions were applied: 21 single interventions and 22 combination interventions. Among the intervention methods, complete decongestive treatment (CDT), resistance training, and manual lymphatic drainage were the most frequently utilized. The most common duration of intervention turned out to be 4~5 weeks and more than 8 weeks, with frequencies of 2~3 sessions per week and more than 4 sessions per week. The most frequently used dependent variables included range of motion (ROM) and disabilities of the arm, shoulder and hand (DASH) for the function and disorder of the upper limb category; arm circumference or volume and bio-impedance for the lymphedema category; visual analogue scale (VAS) and numerical rating scale (NRS) for the pain category; and the European organization for research and treatment of cancer quality of life questionnaire breast cancer module (EORTC QLQ) and functional assessment of cancer therapy-breast (FACT-B) for the quality of life category. Conclusion : The findings of this scoping review provide valuable mapping data for non-pharmacological interventions for physical rehabilitation following breast cancer treatment. We recommend further research, particularly systematic reviews and meta-analyses, to build upon these findings.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• Journal of Hospice and Palliative Care
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• v.12 no.1
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• pp.27-31
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• 2009

Purpose: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. Methods: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. Results: The mean reduction ratio of the volume of edema comparison normal volume was 41.1${\pm}$35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. Conclusion: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.