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Currently, there are many methods to evaluate the effectiveness of manual lymph drainage in the treatment of lymphedema, that is, limb volume measurement, bio-electrical impedance measurement, computer tomography, and ultrasound imaging. However, it is difficult for these methods to accurately address the lymph flow generated by manual lymph drainage. Therefore, we aimed at developing a concise and accurate method to measure the lymph flow through the thoracic duct in human subjects, which is applicable for evaluating the effectiveness of manual lymph drainage. In the present mini-review, we demonstrate the developed method in detail and its scientific evidence for the effectiveness obtained with animal and human clinical experiments. In rat

The aim of this study was to evaluate the effects of complete decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL).Fifty patients with unilateral BCRL were included. The demographic variables focusing on lymphedema were recorded. All patients received combined phase 1 CDT including skin-care, manual lymphatic drainage, multilayer bandaging and supervised exercises, 5 times a week for 3 weeks, as a total of 15 sessions. Patients were assessed by limb volumes and excess volumes according to geometric approximation derived from serial circumference-measurements of the limb, prior and at the end of third week. The functional disability was evaluated by quick disability of arm, shoulder and hand questionnaire (Q-DASH). QoL was assessed by the European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-cancer-module (EORTC QLQ-BR23).Fifty females with mean age of 53.22 ± 11.2 years were included. The median duration of lymphedema was 12 months. There were 22 patients in stage1, 26 in stage2 and 2 patients in stage3. The mean baseline limb and excess volumes were significantly decreased at the end of therapies (3262 ± 753 cm³ vs. 2943 ± 646.6 cm³ and 31.36% ± 16.5% vs. 19.12% ± 10.4%, pP= 0.000 respectively). The Q-DASH and EORTC QLQ-C30 and BR23 scores were also decreased significantly (pP0.05). The improvements in volumes were related negatively with the duration of lymphedema, and the stage of lymphedema.In conclusion phase 1 CDT in a combined manner performed daily for 3 weeks, greatly reduces the volumes as well as improves the disability and QoL, especially when performed earlier.

Introduction: Manual lymphatic drainage (MLD), one of the components of complex decongestive physiotherapy, which is accepted as the gold standard in the treatment of lymphedema, is used for therapeutic purposes in many diseases. The most well-known feature of MLD is that it helps to reduce edema. In addition to reducing edema, MLD has many effects, such as increasing venous flow, reducing fatigue, and raising the pain threshold. To the best of our knowledge, there is no study examining the effects of MLD other than its effects on edema in detail. The aim of this study is to compile effects of MLD and to provide a better understanding of the effects of MLD.

This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer–related lymphedema (BCRL). In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8). Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p

Objectives: To identify predictive factors associated with limb volume reduction using different decongestive lymphatic therapy (DLT) systems in patients with lymphoedema, over a period of up to 28 days. Methods: A multicountry (Canada, France, Germany, the United Kingdom) prospective cohort study using (DLT): skin care, exercise, compression bandaging, and manual lymphatic drainage for up to 4 weeks. Reduction in limb volume comparing DLT with (1) standard multilayer bandaging with inelastic material, and with (2) multilayer bandaging with Coban2, together with the identification of factors associated with limb volume changes. Results: Out of 264 patients with upper or lower limb lymphedema, 133 used Coban2 and 131 used standard care. Following DLT, mean limb volume reduction was 941 mL using Coban2 compared with 814 mL using standard care. A difference of 127 mL was found (95% confidence interval -275 to 529 mL, p = 0.53). Of the 176 patients with leg swelling, 166 (94.3%) had a limb volume measurement after 28 days and were included in the risk factor analysis. Of these, 132 (79.5%) were female, with overall mean age of 60.1 years (standard deviation = 14.7), with secondary lymphedema in 102/163 (62.6%). Duration of lymphedema was >10 years in 75/161 (46.6%) and 99/166 (59.7%) were International Society of Lymphology late-stage II/III, indicating longstanding and/or a high frequency of patients with advanced stages of lymphedema. Ninety-one (54.8%) received Coban2 and 75 (45.2%) had standard care. Multivariable factors for a greater leg volume reduction were large initial leg volume (p < 0.001), DLT treatment duration of 4 weeks compared with 2 weeks (p = 0.01), and peripheral arterial disease (p = 0.015). Conclusion: Limb volume changes were found to be similar between groups. Lack of standardization of DLT makes interpretation of effectiveness problematic. There is an urgent need for randomized-controlled trials. Despite this, severe lymphedema with a large limb volume responded well to DLT in this study.

The article describes the general principles of manual lymphatic drainage correction. The authors evaluated the effectiveness of its application in the complex therapy of recreational rehabilitation of athletes with myofascial pain syndrome (MPS).Objective: to evaluate the effectiveness of general manual lymphatic drainage correction in the treatment of athletes with MPS.Materials and Methods:a total of 30 rugby players were examined. All athletes from the main group received physiotherapy, general lymphatic drainage massage. Patients from the control group underwent the same procedures and general massage without lymphatic drainage correction. The course of therapy included 6 procedures.Results: tensoalgometric parameter values in athletes from the main group increased by more than 5 times after lymphatic drainage correction. In sportsmen from the control group, these parameter values decreased.Conclusion: the application of manual lymphatic drainage contributes to the active restoration of myotatic reflex of physical muscles and regress of pain syndrome in athletes.

Die Behandlung von Patienten mit komplexem regionalem Schmerzsyndrom („complex regional pain syndrome“ [CRPS]) findet in einem interdisziplinaren und multimodalen Setting statt. Physikalische Therapien stellen neben physio- und ergotherapeutischen sowie analgetischen Behandlungen einen wesentlichen Behandlungsschwerpunkt dar. Die vorliegende Ubersicht erlautert den Stellenwert im aktuellen klinischen Alltag und vermittelt einen Eindruck der Evidenzlage verschiedener Behandlungen, beispielsweise zu Elektrotherapie, neuromodulierenden Verfahren, manueller Lymphdrainage, CO2-Anwendungen und Paraffinbadern. Soweit aus der klinischen Erfahrung und der wissenschaftlichen Literatur erkennbar, werden die Behandlungsempfehlungen in Abstimmung mit den aktuellen Leitlinien dargestellt.

Background: Breast cancer-related lymphedema (BCRL) is a major side effect and a complication of breast cancer surgery and radiotherapy, causing chronic lymphedema in the arm. Aim of Study: This study was conducted to compare between efficacy of Endermologie and Low Level Laser Therapy (LLLT) in treatment of post mastectomy lymphedema. Subjects and Methods: Thirty women diagnosed clinically by oncologist/physician as unilateral breast cancer with secondary upper limb lymphedema post mastectomy, they were selected from Damanhour Oncology Centre suffering from grade II lymphedema without skin changes one year post mastectomy based on tape and volumetric assessment. Their age ranged from 40 to 60 years. They were assigned randomly into two groups (A) and (B) equal in number. Group (A) received 30min Endermologie 3 times per week in addition to routine physical therapy program (manual lymphatic drain-age, compression bandage, active range of motion and eleva-tion), hygiene and skin carefor 6 weeks. While, Group (B) received 20min LLLT 3 times per week in addition to routine physical therapy program (manual lymphatic drainage, com-pression bandage, active range of motion and elevation), hygiene and skin care for 6 weeks. Upper limb lymphedema was evaluated by tape and volumetric assessment before and after the intervention. Results: There was no significant difference in upper limb volume and circumference between both groups pre-treatment (p>0.05). Comparison between the group (A) and (B) post-treatment revealed a significant decrease in upper limb volume and circumference of the group (A) compared with that of the group (B) (p>0.05). Conclusion: These results suggested that Endermologie was more effective than LLLT in reducing limb circumference and volume in post mastectomy lymphedema.

Introduction. Cellulite is associated with variations in the skin appearance with cottage cheese, mattress-like, or orange peel. The most common areas for these lesions are the posterior or upper thighs and buttocks and mainly affect females after puberty. The objective of the study was to determine whether extracorporeal shock wave therapy (ESWT) or manual lymphatic drainage (MLD) is more effective for the reduction of the grade of cellulite after liposuction. Methods. This study is a single-blinded randomized controlled clinical trial. Thirty females with grade 3 cellulite were randomly distributed into two groups equal in number (n = 15), group A was equipped to ESWT and group B was equipped to MLD. The cellulite grading scale was used to assess cellulite grade, and the skinfold caliper was used to assess the thickness of subcutaneous fat. The assessment was carried out before and four weeks after starting the treatment. Both groups received topical retinol twice daily for four weeks; in addition, group A received ESWT, while group B received MLD, two times/week for 4 weeks. Results. The mean values of the skinfold caliper in group A decreased by 24.4% and in group B by 15.38% with a significant difference between the two groups p < 0.001 . Also, the mean values of the cellulite grading scale decreased significantly after treatment in group A compared with the mean values of group B p < 0.001 . Conclusions. There was more reduction in the grade of cellulite and thickness of subcutaneous fat in the ESWT group than the MLD group after liposuction.

Background: Manual lymph drainage (MLD) is one of the common treatments for breast cancer-related lymphedema (BCRL). Although the primary goal of MLD is to drain the excessive fluid accumulated in the affected upper limb and trunk to an area of the body that drains usually, the use of MLD is decided based on swelling and subjective symptoms, without assessing whether there is fluid accumulated in the affected region. The purpose of this study was to examine truncal fluid distribution in a sample of BCRL patients and investigate any correlation between such fluid distribution and swelling or subjective symptoms. Methods and Results: An observational study was conducted with 13 women who had unilateral, upper extremity BCRL. Fluid distribution was evaluated by using two magnetic resonance imaging (MRI) sequences: half-Fourier acquisition single-shot turbo spin echo and three-dimensional double-echo steady-state. The presence of swelling was determined by lymphedema therapists, and subjective symptoms were measured by using a visual analog scale. On MRI, no participants had any free water signals in the trunk. However, seven had swelling and all 13 had some kind of subjective symptoms on the affected side of their trunk. Conclusions: These results suggest that swelling and subjective symptoms do not correlate with the presence of truncal fluid. For such cases, a different approach than MLD may be needed to address truncal swelling and related subjective symptoms. Checking for the presence of fluid in the truncal region may help MLD be used more appropriately.

Although arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, including axillary surgery, high body mass index (BMI), increased bra cup size, adjuvant chemotherapy, locoregional and radiotherapy boost, and upper outer quadrant tumors. We aimed to provide a review to help avoiding or management of breast lymphedema. The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct a literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative, and surgery to search the Embase database. All papers published in English were included with no exclusion date limits. A total of 2155 female patients were included in this review; age ranged from 26 to 90 years. The mean BMI was 28.4 of the studies that included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as BMI, breast size, tumor size, tumor site, type of surgery, and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including manual lymphatic drainage, self-massaging, compression bras, or Kinesio taping. Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

The study was designed to compare the effectiveness of complex decongestive therapy versus extracorporeal shockwave therapy for the treatment of lymphedema secondary to breast cancer. Twenty patients with a diagnosis of breast cancer–related lymphedema were randomized into two groups. Group 1 patients received complex decongestive therapy consisting of manual lymphatic drainage, bandaging, exercise, and compression garments for 5 days a week for a total of 20 sessions. Group 2 patients received a total of 12 sessions of extracorporeal shock wave therapy three times a week. All patients were evaluated using volumetric and circumferential measurements and Quick DASH scores at baseline, posttreatment, and first month after treatment. Within-group assessment of patients in each group showed statistically significant reductions in volumetric and circumferential measurements and a significant improvement in Quick DASH scores at posttreatment and first month after treatment compared with baseline (p 0.05). For patients with lymphedema secondary to breast cancer, extracorporeal shock wave therapy can be an alternative treatment to complex decongestive therapy.

Objectives: To investigate the effect of kinesio taping (KT) and manual lymphatic drainage (MLD) on pain severity, breast engorgement, and milk volume in postpartum women. Materials and Methods: In...

Fibromyalgia is a chronic disease of unknown origin characterized by widespread pain, fatigue, disordered sleep and joint stiffness among other symptoms. To compare outcomes of manual lymph drainage and myofascial therapy in patients with fibromyalgia. This was a systematic review. The databases PubMed/MEDLINE, CINAHL, SCOPUS, ScieLo, PEDro, Dialnet, Web of Science, and Elsevier were searched for articles in English or Spanish examining the efficacy of myofascial therapy and/or manual lymph drainage to treat fibromyalgia. Of 356 articles extracted, sixteen articles and one doctoral thesis fulfilled the criteria established for inclusion. The methodological quality of the studies reported in the articles was good (PEDro score 7.49 ± 1.47). The studies included compared different treatments with lymph drainage and/or myofascial therapy. Outcomes indicated improved quality of life for both therapies in all the studies. Myofascial therapy and lymph drainage may be effective in patients with fibromyalgia. Further work is needed as the scientific evidence available is still insufficient.

Background Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. Methods Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). Results Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. Discussion It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. Limitations The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. Trial registration This trial was registered in ClinicalTrials.gov (NCT03762044). Date of registration: 23 November 2018. Prospectively Registered.

Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphedema. This systematic review aims to examine the methodologies used in recent research and evaluate the effectiveness of MLD for those at-risk of or living with lymphedema. The electronic databases Embase, PubMed, CINAHL Complete and Cochrane Central Register of Controlled Trials were searched using relevant terms. Studies comparing MLD with another intervention or control in patients at-risk of or with lymphedema were included. Studies were critically appraised with the PEDro scale. Seventeen studies with a total of 867 female and two male participants were included. Only studies examining breast cancer-related lymphedema were identified. Some studies reported positive effects of MLD on volume reduction, quality of life and symptom-related outcomes compared with other treatments, while other studies reported no additional benefit of MLD as a component of complex decongestive therapy. In patients at-risk, MLD was reported to reduce incidence of lymphedema in some studies, while others reported no such benefits. The reviewed articles reported conflicting findings and were often limited by methodological issues. This review highlights the need for further experimental studies on the effectiveness of MLD in lymphedema. There is some evidence that MLD in early stages following breast cancer surgery may help prevent progression to clinical lymphedema. MLD may also provide additional benefits in volume reduction for mild lymphedema. However, in moderate to severe lymphedema, MLD may not provide additional benefit when combined with complex decongestive therapy.

Introduction: Blepharoplasty word is of Greek origin (blepharos refers to the eyelids, and plasty is on the form, shape), used to call the eyelid rejuvenation surgery. The physical therapy can prevent or reduce many of the complications caused by blepharoplasty, such as swelling, bruising, hematoma, keloid, among others. Objective: This project aims to observe the physiotherapy performance in the post-blepharoplasty, assessing the general condition of the patient, as the possible complications of surgery. Methods: This study is characterized as a clinical trial and quasi-experimental. The survey sample contains 8 participants (n = 8). Inclusion criteria were patients who had undergone blepharoplasty surgery at the Institute of Vision, female, with a mean age of 60.1 years, menopausal and time availability in the morning and / or afternoon. Exclusion criteria were patients who missed 3 or more sessions, presence of eye diseases such as conjunctivitis, exacerbated pain in the surgery area, infection in the incision area and to provide dehiscence. They started treatment in the second postoperative day, being applied to pumping technique with the use of gauze on the upper eyelid region, manual lymphatic drainage (MLD) and kinesiotherapy in a 40 minute session, with the total of 10 sessions. Results: The level of education of patients and their professions was observed to changes in the postoperative period, the quality of life of patients and duration of the presence of complications. Conclusion: It is suggested that physical therapy in the daily early postoperative period of blepharoplasty may have contributed to avoid complications and that blepharoplasty does not affect the quality of life.

Perineal trauma (PT) may be considered as a very common injury during the childbirth. The incidence of PT was estimated in 30% to 85%, with 60% to 70% requiring suture. The present study was a prospective, single‐blinded, randomised, clinical trial carried out from January 2015 to January 2016. For this study, 49 secundigravida women diagnosed with gestational oedema were recruited and randomly divided into two groups (A and B). Group A (n = 30) received the conventional treatment plus perineal massage and group B (n = 19) the conventional treatment plus manual lymphatic drainage (MLD). Visual analogue scale (VAS) and King Health's Questionnaire (KHQ) were performed to assess pain intensity and quality of life‐related with urinary incontinence (UI). Pain intensity measurements showed statistically significant differences for a decrease after 30‐weeks (P = .037), after 36‐weeks (P = .000), and at the end of puerperium (P = .014) for MLD with respect to perineal massage group. Moreover, inter‐groups repeated measures ANOVA for the values related statistically significant differences to the interaction of each applied treatment (perineal massage and MLD group, separately) over the pain intensity variable. MLD treatment reduced pain intensity with respect to perineal massage in secundigravida women with gestational oedema from 25‐weeks of gestation to the end of puerperium. Sin financiación 3.315 JCR (2020) Q2, 29/68 Dermatology 0.867 SJR (2020) Q1, 23/138 Dermatology No data IDR 2019 UEM

Background Postmastectomy lymphedema can be considered the main cause of upper extremity functional impairment in patients with breast cancer. Fatigue, pain, and limited range of motion are common symptoms. If left untreated, lymphedema causes cellulitis, which can lead to gangrene in rare cases. This study was carried out to identify and compare the therapeutic advantages of virtual reality-based exercises and proprioceptive neuromuscular facilitation for postmastectomy lymphedema. Thus, a quasi-randomized comparative study of thirty female patients with unilateral postmastectomy lymphedema was conducted. Fifteen patients performed virtual reality-based exercises as well as manual lymphatic drainage, pneumatic compression, and home programs, while the other fifteen patients performed proprioceptive neuromuscular facilitation as well as manual lymphatic drainage, pneumatic compression, and home programs. The excess arm volume between the healthy and affected limbs was estimated before and after eight sessions of treatment for both groups. In addition, the affected limb functional score was calculated. Arm volume was calculated by the truncated cone formula and girth measurements obtained by the circumferential method. The Arabic version of the QuickDASH-9 scale was used to assess extremity function. Results The excess arm volume significantly decreased in both the virtual reality group (p = 0.001) and proprioceptive neuromuscular facilitation group (p = 0.005), and there was no significant difference between the two groups (p = 0.902). Age was inversely related to the improvement percentage of the QuickDASH-9 score in the virtual reality group. The functional improvement percentage was statistically significantly different between the two groups (p = 0.045). Conclusion It can be concluded that both virtual reality and proprioceptive neuromuscular facilitation have a beneficial therapeutic effect on edema in patients with unilateral postmastectomy lymphedema; neither method was found to be superior, except virtual reality was found to be superior to proprioceptive neuromuscular facilitation in motivating patients and providing visual feedback. Trial registration ClinicalTrials.gov, NCT04185181 Registered 4 December 2019 - Retrospectively registered.

O Fibro Edema Gelóide (FEG) constitui uma alteração cutânea comum e de grande importância para a maioria das mulheres, a partir da puberdade. Apresenta etiopatogenia complexa e multifatorial, causando transtornos estéticos, problemas álgicos, psicológicos e sociais. Existem diversos recursos e tratamentos estéticos invasivos e não invasivos disponíveis para tratar esta disfunção dermatofuncional, tais como: radiofrequência, carboxiterapia, dispositivos baseados em ondas de choque, ultrassom terapêutico, associado ou não a agentes farmacológicos, a drenagem linfática manual, e o microagulhamento. Foi realizada uma revisão bibliográfica nas bases de dados virtuais Portal Periódicos Capes e PubMed (MEDLINE), de estudos que abordavam o tratamento estético do FEG, publicados no período de 2009 a 2018. O objetivo desta revisão foi abordar a importância e eficácia das terapias estéticas invasivas e não invasivas utilizadas no tratamento do FEG. Observou-se que a associação entre duas ou mais terapias estéticas foi mais eficaz para a melhora da aparência da pele e do quadro do FEG do que utilizando-se apenas uma terapia isolada. Entretanto, há estudos com falta de padronização das técnicas e métodos de avaliação dos resultados obtidos, dificultando inferências acerca dos níveis de evidência e eficácia das terapias. Conclui-se que há necessidade de se investigar se determinadas terapias utilizando-se radiações eletromagnéticas podem ser usadas, com segurança, em todas as áreas do corpo, bem como em todas as populações de pacientes. Portanto, estimular mudanças no estilo de vida dos pacientes, assim como, novas investigações sobre o tema com desenhos metodológicos adequados são imprescindíveis.

Objective: Breast cancer-related lymphedema (BCRL) is a major sequela after surgery or radiotherarpy for breast cancer. Manual lymphatic drainage...

Summary: Backgrounds: Costs for manual lymphatic drainage (MLD) paid by the Statutory Health Insurances (SHI) have increased disproportionately in Germany in the last decade. There is no obvious reason that this increase is due to an increasing number of patients with lymph edema. We therefore assume that there are large numbers of patients with obesity and obesity-associated dependency syndrome who drive the cost of MLD and did a retrospective analysis of the correlation between hospitalization rates for lymph edema and obesity and MLD prescription rates in outpatients. Patients and methods: Roughly 90 % of the German population is insured by the Statutory Health Insurance. From its reports we extracted data regarding costs and numbers of MLD session prescribed annually. Hospitalization rates for lymph edema (codes I89.*, I97.2 and Q82.0) and for obesity (ICD E66.*) were provided by the Federal Statistical Office after a specific remote analyses. Results: In the years 2008 to 2016, the MLD prescriptions in the individual federal states increased by + 43.5 % in Berlin to + 109.3 % in Mecklenburg-Western Pomerania. Number of hospitalizations with the principal diagnosis (condition, which caused the admission) hereditary and postmastectomy lymph edema are low and decreased in most federal states. Number of hospitalizations with the additional diagnosis (conditions that coexist at the time of admission or develop subsequently) obesity increased with a range from + 4.8 % in Baden-Württemberg to + 86.4 % in Mecklenburg-Western Pomerania. The correlation between the increase in prescribed MLD in the individual federal state and the increase in hospitalization rates per 1000 inhabitants of cases with obesity is greater (R2 0.4696) than with lymph edema (R2 0.0987). Conclusions: Our analysis is in line with the hypothesis that there is a correlation between the increasing prescription rate of MLD and the increasing burden of obesity in Germany.

Isolated penile lymphedema is a rare but severely disabling condition due to reduced lymphatic drainage. In this area treatment opportunities are poor being that conservative management is usually not effective and surgery limited to debulking lymphangiectomy, which is indicated only in very severe cases. Lymphovenous anastomosis (LVA) has a demonstrated efficacy in treatment of upper and lower limbs lymphedema but still has few applications in genital lymphedema and none when the swelling is confined in the penis. Here we present a case of an isolated penile lymphedema treated with super-microsurgical LVA. A 33-year-old patient presented swelling and pain immediately after a traumatic injury at the base of the penis. After 2 years of conservative praxis with manual lymphatic drainage of the penis and upper thigh bandage compression, no improvement of the symptoms was obtained. Indocyanine green lymphography was performed with dye injection in the glans confirming the diagnosis by showing lymphatic drainage stasis (dermal backflow). We consequently decided to undergo a surgical procedure performing lymphovenous anastomosis at the dorsum of the penis. Immediately following this intervention, both objective and subjective symptoms relief were noted with decrease of swelling and pain. The postoperative course was uneventful and at the 6 months follow up the patient reported no recurrence of the swelling even with the complete removal of compression therapy. We consider therefore that LVA may be a valid possibility for management of similar cases to provide a definitive clinical improvement.

Background Primary lower limb lymphedema is a chronic debilitating disorder without curative treatment. The initial treatment phase is dedicated to reducing lymphedema volume, whereas the second aims to stabilize that volume. Objective The objective of this study was to analyze clinical and lymphoscintigraphic characteristics during complete decongestive physical therapy as predictors of primary unilateral lower limb lymphedema-volume reduction. Design This observational, retrospective study included 222 consecutive patients (January 2009–January 2017; median age: 45.8 years) with lymphedema affecting the entire lower limb, who received complete decongestive physical therapy for the first time in a specialized lymphedema management center. Methods Complete decongestive physical therapy consisted of low-stretch bandaging, manual lymph drainage, exercises, and skin care for all patients. Lymphoscintigraphy preceded treatment. Results Median lymphedema evolution was 73 months, and median excess volume was 34%. Median (interquartile range) lymphedema volumes were 2845 (1038–3487) mL before and 1276 (601–2195) mL after a median of 11 days of complete decongestive physical therapy, with 34% median reduction. Multivariate analyses retained age, body mass index >40 kg/m2, and previous cellulitis, as independently associated with lymphedema volume reduction. For each additional year of age, volume reduction increased 0.16%. Unexpectedly, log-transformed initial lymphedema volumes indicated a negative impact, that is, 4.95%, for each log-unit gain. Patients with previous cellulitis episode(s) obtained 6.9% and those with BMI >40 kg/m2 17.1% higher lymphedema volume reductions. Lower limb lymphoscintigraphy was available for 150 (67.6%) patients. Having dermal back flow was associated with greater lymphedema volume reduction than not (respectively, 39% vs 31%). Limitations This study was retrospective, and only 67.6% of patients underwent lymphoscintigraphy. Conclusion Our analysis identified clinical and scintigraphic predictors of primary lymphedema volume reduction for patients with unilateral disease. Lymphoscintigraphy helps confirm lymphedema and predict volume reduction. Further study is required to confirm these observations.

Lymphedema (LE) is a progressive chronic disorder, frequently related to malignancies and their treatment in Western countries. It markedly affected patients' quality of life, and its management is challenging, mainly based on conservative therapy, as bandages and manual lymphatic drainage, with limited results.Recent advances in imaging technology and microsurgical techniques have changed the approach to this disorder, particularly the recent application of magnetic resonance for the study of LE and the increasingly widespread use of surgical interventions, such as vascularized lymph node transfer. As secondary LE due to radical prostatectomy and/or radiation treatment is a frequent cause of chronic disability in the male population, and few data are available in literature about which imaging technique can be applied to diagnose it and about the surgical modalities to treat this condition, we want to propose an overview on the lymphatic vessels anatomy and function, on the applications of noncontrast magnetic resonance lymphangiography and about the pieces of information this examination can provide, and on the technique of vascularized lymph node transfer and the rationale of this surgical procedure in secondary LE related to prostatic malignancy treatment.

Background: Lymphedema (LE) is a chronic condition that requires lifelong treatment. Although pneumatic compression therapy (PCT) is one treatment option, current algorithms consider it as an adjun...

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome—percentage tissue water—measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.

BACKGROUND Vascularized lymph node transfer is an efficacious treatment for extremity lymphedema. This study investigated the outcome of retrograde manual lymphatic drainage for vascularized lymph node transfer to distal recipient sites. METHODS Lymphedema patients who underwent either complete decongestive therapy or vascularized lymph node transfer between 2013 and 2018 were retrospectively included. Retrograde manual lymphatic drainage was started with intermittent manual compression and the assistance of a sphygmomanometer and proximal-to-distal massage of the limb 1 month postoperatively. Outcomes evaluations used the circumferential reduction rate and the Lymphedema-Specific Quality-of-Life Questionnaire. Outcomes of vascularized lymph node transfer to proximal versus distal recipient sites in the literature between 2006 and 2018 were also compared. RESULTS One hundred thirty-eight unilateral extremity lymphedema patients, including 68 patients in the complete decongestive therapy group and 70 patients in the vascularized lymph node transfer group, were included. The mean circumferential reduction rate of 38.9 ± 2.5 percent in the vascularized lymph node transfer group was statistically greater than the 13.2 ± 10.1 percent rate in the complete decongestive therapy group (p = 0.01). At a mean follow-up of 36 months, the improvement of overall Lymphedema-Specific Quality-of-Life Questionnaire score from 3.8 ± 0.3 to 7.5 ± 1.8 in the vascularized lymph node transfer group was statistically greater than that in the complete decongestive therapy group (from 4.7 ± 0.9 to 5.0 ± 1.9; p < 0.01). In total, 536 lymphedema patients who underwent 548 vascularized lymph node transfers in 23 published articles were reviewed; the distal recipient-site group was found to have more efficacious results than the proximal recipient-site group. CONCLUSION Vascularized lymph node transfer to a distal recipient site with standard retrograde manual lymphatic drainage significantly improved circumferential reduction rates and Lymphedema-Specific Quality-of-Life Questionnaire scores. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

Background and Objectives: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with fluid accumulation in the interstitial tissue. Manual lymphatic drainage (MLD) plays a role in reducing lymphoedema, like intermittent pneumatic compression (IPC). By the present pilot study, we aimed to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Materials and Methods: Adults with a clinical diagnosis of T2DM and lower limb lymphedema (stage II–IV) were recruited from July to December 2020. Study participants were randomized into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg), control group, undergoing MLD and a sham IPC (with compression of &lt, 30 mmHg). The primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle, quality of life, laboratory exams as fasting plasma glucose and HbA1c. At baseline (T0) and at the end of the 1-month rehabilitative treatment (T1), all the outcome measures were assessed, except for the Hb1Ac evaluated after three months. Results: Out of 66 T2DM patients recruited, only 30 respected the eligibility criteria and were randomly allocated into 2 groups: experimental group (n = 15, mean age: 54.2 ± 4.9 years) and control group (n = 15, mean age: 54.0 ± 5.5 years). At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p &lt, 0.05). The between-group analysis showed a statistically significant improvement in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L index at T1. Conclusions: A multimodal approach consisting of IPC and MLD showed to play a role in reducing lower limb lymphedema, with an increase of pROM and HRQoL. Since these are preliminary data, further studies are needed.

The World Health Organization (WHO) has recognised obesity as one of the top ten threats to human health. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of an increased release of biologically active metabolites. Moreover, obesity predisposes the development of metabolic syndrome and increases the incidence of type 2 diabetes (T2DM), increases the risk of developing insulin resistance, atherosclerosis, ischemic heart disease, polycystic ovary syndrome, hypertension and cancer. The lymphatic system is a one-directional network of thin-walled capillaries and larger vessels covered by a continuous layer of endothelial cells that provides a unidirectional conduit to return filtered arterial and tissue metabolites towards the venous circulation. Recent studies have shown that obesity can markedly impair lymphatic function. Conversely, dysfunction in the lymphatic system may also be involved in the pathogenesis of obesity. This review highlights the important findings regarding obesity related to lymphatic system dysfunction, including clinical implications and experimental studies. Moreover, we present the role of biological factors in the pathophysiology of the lymphatic system and we propose the possibility of a therapy supporting the function of the lymphatic system in the course of obesity.

Breast cancer-related lymphedema (BCRL) is an increasingly common complication seen in the palliative care setting due to increased life expectancy of breast cancer survivors. It is an important determinant of the quality of life of breast cancer survivors, due to the functional impact that it has, apart from the pain and deformity associated with it. Conservative management of lymphedema with the help of physiotherapy, positioning, manual lymphatic drainage, and intermittent pneumatic compression is well known. Even then, there remains a subset of patients that fail to respond to conservative management. T2 sympathectomy is a technique which ablates the thoracic sympathetic chain and helps in improving the lymphatic drainage. We report a series of four cases of BCRL, which showed a significant reduction in the mid-arm circumference as well as pain scores after a T2 sympathectomy. We believe that T2 sympathectomy can be used as the second line of management in lymphedema patients in whom conservative treatment has failed.

This study documents the development and evaluation of a comprehensive multidisciplinary model for the assessment and personalized care of patients with lymphoedema.The Australian Lymphoedema Education Research and Treatment (ALERT) programme originated as an advanced clinic for patients considering surgery for lymphoedema. The programme commenced liposuction surgery in May 2012 and then introduced lymph node transfer in 2013 and lymphovenous anastomosis (LVA) in 2016. An outpatient conservative treatment clinic was established in 2016. ALERT commenced investigations with indocyanine green (ICG) lymphography in late 2015, leading to the creation of a diagnostic assessment clinic offering ICG in 2017.Since 2012, 1200 new patients have been referred to ALERT for assessment of lymphoedema for a total of 5043 episodes of care. The introduction of ICG lymphography in 2015 initially allowed better screening for LVA, but is now used not only to guide surgical options, but also as a diagnostic tool and to guide manual lymphatic drainage massage. The total number of new patients who attended the surgical assessment clinic to December 2018 was 477, with 162 patients (34·0 per cent) undergoing surgery.The ALERT programme has developed a multidisciplinary model of care for personalized lymphoedema treatment options based on clinical, imaging and ICG lymphography. Patients are selected for surgery based on several individual factors.Este estudio presenta el desarrollo y valoración de un modelo multidisciplinario integral para la evaluación y atención personalizada de pacientes con linfedema. MÉTODOS: El programa australiano de educación en investigación y tratamiento del linfedema (Australian Lymphoedema Education Research and Treatment, ALERT) se originó como un centro clínico avanzado para pacientes que consideran la cirugía como tratamiento para el linfedema. El programa se inició en mayo del 2012 con la cirugía de liposucción, introduciendo la cirugía de transferencia ganglionar (lymph node transfer, LNT) en 2013 y la anastomosis linfovenosa (lymphovenous anastomosis, LVA) en 2016. En 2016 se estableció una clínica de tratamiento conservador ambulatorio. ALERT comenzó las investigaciones con la linfografía con verde de indocianina (indocyanine green, ICG) a fines del 2015, lo que se siguió de la creación de una clínica de evaluación diagnóstica que ofrece ICG en 2017.Desde el 2012, 1.200 pacientes nuevos han sido referidos a ALERT para la evaluación de un linfedema, con un total de 5.043 episodios atendidos. La introducción inicialmente de linfografía con ICG en 2015 permitió un mejor cribaje para LVA, pero actualmente se utiliza no solo como guía de las opciones quirúrgicas, sino también como herramienta diagnóstica y como guía del masaje de drenaje linfático manual (manual lymphatic drainage, MLD). El número total de pacientes nuevos atendidos en la clínica de evaluación quirúrgica hasta diciembre de 2018 fue de 477, con 122 pacientes (34%) tratados quirúrgicamente. El modelo tal como se ha descrito, ha atraído a pacientes de toda Australia y Nueva Zelanda. CONCLUSIÓN: El programa ALERT ha desarrollado un modelo multidisciplinario de atención para las opciones de tratamiento personalizado del linfedema basado en la evaluación clínica, por imagen (MRI y LSG) y linfografía con ICG. Los pacientes se seleccionan cuidadosamente para el tratamiento quirúrgico en función de varios factores relacionados con el paciente, el tumor, los linfáticos y las opciones terapéuticas, y se someten a una evaluación detallada después de cualquier procedimiento.

Background Lymphedema (LE) has been called the forgotten vascular disease, given such scant knowledge about LE-associated comorbidities or causes. Such knowledge of the comorbidities and treatment of LE may assist in diagnostic decisions and health care planning. Methods To determine the proportion of LE patients with various LE-associated comorbidities as well as the rate of associated treatment, deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative claims from the Blue Health Intelligence (BHI) research database (165 million Blue Cross Blue Shield members) were queried. We analyzed a BHI study sample of 26,902 patients with LE who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016. Patients were first identified by comorbidity and then grouped into those receiving no treatment for LE and those receiving any treatment for LE. Any treatment was defined as receiving manual lymphatic drainage, physical therapy, compression garments, or a pneumatic compression device. The purpose of this study was to determine the proportion of LE patients comorbid with various known LE-associated conditions and the treatment rates of LE patients with each comorbidity. Results Among the 84,579,269 BHI patients enrolled during the study window, 81,366 patients were identified with LE. From this LE group, our study focused on the 26,902 patients who were enrolled with continuous medical and pharmacy benefits for 12 months before and after the index date. Among these 26,902 LE patients, breast cancer was the most frequent comorbidity with LE (32.1%), and these patients almost universally received any treatment (94.2%); other cancer types, such as melanoma (2.1%) and prostate cancer (0.7%), were less frequent and received any treatment less often, 75% and 82% of the time, respectively. Venous leg ulcer was the most common non-cancer-linked comorbidity for LE (9.6%), but only 81.7% of venous leg ulcer patients received any treatment for LE. Conclusions To our knowledge, this is the largest study to date detailing the comorbidities associated with LE and LE treatment rates within each. Our findings suggest that a sizable proportion of cancer-related LE patients do not receive appropriate treatment. Furthermore, this study highlights the role of advanced venous disease as an LE comorbidity that is frequently untreated and its associated gap in treatment.

La rehabilitación oncológica es dirigida a aquellos pacientes con un diagnóstico de cáncer, el cual deriva discapacidad debido a la cirugía, la quimioterapia y la radioterapia. El reporte de caso corresponde a un paciente masculino, de 63 años de edad, diagnosticado en 2017 de un carcinoma epidermoide de amígdalas palatinas T3N2M0 al cual le realizaron una amigdalectomía un mes después del diagnóstico. Posterior a ello recibió 30 sesiones de radioterapia y 2 sesiones de quimioterapia en total. Fue remitido al servicio de Terapia física de la Clínica Santa Paula 4 meses después de la cirugía debido a las alteraciones posturales que ésta produjo. Asistió a rehabilitación una vez a la semana, durante un año. El abordaje consistió en la aplicación de crioterapia, drenaje linfático manual, masaje liberador de cicatriz, liberación de puntos gatillo, electroterapia, estabilidad espinal y técnicas de terapia manual logrando mejorar ampliamente la evaluación inicial. La rehabilitación oportuna pero a la misma vez continuada (al menos 1 año) en pacientes post cirugía de cáncer de amígdala podría ser beneficiosa para el manejo de las alteraciones posturales que ésta provoca, siendo más efectiva la combinación de técnicas fisioterapéuticas que el uso aislado de las mismas.

El linfedema es un tipo de edema que se caracteriza por un aumento anormal de líquido intersticial rico en proteínas en los tejidos afectados. Su etiología puede ser primaria o secundaria. El más frecuente en nuestro medio es el linfedema de miembro superior secundario al tratamiento del cáncer de mama. El linfedema de miembro inferior suele deberse el tratamiento del cáncer ginecológico. El tratamiento conservador más habitual es la terapia física descongestiva compleja, que consta de cuidados de la piel, drenaje linfático manual, ejercicio físico, educación terapéutica y terapia compresivaSe presenta el caso de una paciente con diagnóstico de linfedema de miembro inferior de grado III secundario a un cáncer de endometrio a la que se aplica un vendaje multicapa de baja elasticidad durante cinco días consecutivos, sin más tratamiento, que es renovado en cada sesión. El primer y último día de tratamiento se mide el volumen de la extremidad afecta de linfedema para estimar la reducción de volumen mediante la fórmula de Markowski. Se observó una disminución de volumen del linfedema del 2.84%.

Background: The presence of cellulite is an aesthetically unacceptable cosmetic problem for most post-adolescent women that can appear post liposuction, it is characterized by dimpled or puckered skin. Manual lymphatic drainage and pneumatic compression pump may be effective in improving cellulite after liposuction.Aim of Study: This study is conducted to compare the effect of manual lymphatic and pneumatic compression pump on cellulite in females post liposuction.Subjects and Methods: Thirty female patients with cellulite grade 3 post liposuction at their thighs participated in this study. Their ages ranged from 25 to 45 years. They were selected from the outpatient clinic of Plastic Surgery Depart-ment at Cairo University Hospitals and were divided into two equal groups, each group consisted of 15 patients. Group (A) received manual lymphatic drainage and walking on treadmill three times per week for 8 weeks. Group (B) received pneu-matic compression pump and walking on treadmill three times per week for 8 weeks. Methods of evaluation are cellulite grading scale and thigh circumference.Results: There was a significant decrease in severity of cellulite in manual lymphatic drainage group when compared with pneumatic compression group.Conclusion: Manual lymphatic drainage is superior to pneumatic compression pump in the treatment of cellulite.

Background: Chronic edema/lymphedema is defined as edema present for more than 3 months. It is underrecognized and undertreated. The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema in heterogeneous populations. Canada participated in this study. Methods and Results: Participants were recruited from an outpatient chronic wound management clinic. At a study visit, the following tools were administered: The Core Tool, Demographics and Disability assessment (WHODAS 2.0), Quality-of-life assessment (LYMQOL + EQ-5D), Details of swelling, Wound assessment, and Cancer. Data were entered into an international database (Clindex), and country-specific data were analyzed. Sixty-eight subjects were enrolled. Fifty-seven percent were males and 43% females. More than 90% were older than 45 years. Only 7.35% had primary lymphedema. Most had lower extremity edema (65 of 68). Over half (47.06%) were morbidly obese with body mass index of >40. The most common underlying condition was venous disease. Only 8 of 68 had a history of cancer. While 72.06% had a history of cellulitis, only 10.2% had been hospitalized in the past year. 39.71% had an open wound. More than 75% had received multilayer bandaging, compression garments, wound dressings, and extensive counseling. Few had received manual lymphatic drainage, which is not funded. Disability was less than expected. Conclusion: Chronic edema/lymphedema is an underrecognized condition. These data and the wider LIMPRINT study are important tools to advocate for wider recognition and funding of treatment by health care systems.

Edema of advanced cancer, seldom recognized in the literature, significantly impairs patient quality of life.The purpose was to assess edema frequency, etiology, and impact on common symptoms and present its conservative management.A prospective analysis of 784 patients admitted to a hospice was performed, of whom 119 were diagnosed with edema. For 18 patients with short life prognosis, an individually tailored physiotherapy (limb elevation, bandaging, manual lymphatic drainage, and Kinesio Taping) or subcutaneous needle drainage was administered. Forty-six patients with longer prognosis were treated by standardized limb bandaging (5-7 days) and re-evaluated, 28 of them with venous congestion resistant to enteral diuretics received supplementary furosemide infusion.Among those admitted with edema (96.6% with advanced cancer), 81.5% had bilateral and 10.9% generalized edema, 10.9% had lymphorrhea, 5.9% skin ulcerations, and in 27.7% edema was the main problem. The high mean comorbidity C3-index score (2.97) was observed. The main precipitating factors of the edema were chronic immobilization (79.8%) medications (58.8%), and congestive heart failure (28.6%). Before admission, 47.9% had received diuretics for edema and only 4.2% had physiotherapy. Among those re-evaluated (46 patients [84 limbs]), the mean reduction of limb volume (1.18L; 16.6%; P0.001) was accompanied by a decrease of edema symptoms/signs intensity and ESAS-Core by median 1 point (P0.002).Limb edema of advanced cancer occasionally treated by physical therapy concerns patients with numerous comorbidities and precipitating factors. It can be managed sufficiently with decongestive or supportive physiotherapy, depending on patients' life prognosis, symptom burden, edema stage, and progression.

Introduction: Lymphedema is a symptom of morphologically or functionally insufficient lymph transport. There are several etiological factors damaging the lymphatic pathways. Infections and trauma of limb skin and deep tissues evoke reaction of peripheral lymphatics and lymph nodes [1]. Aim and Objective: To compare the “efficacy of pneumatic compression therapy (PCT), lymphatic drainage exercises and control group in patient with lower limb lymph edema. Methodology: Subject randomly assigned into three groups viz group A, B and C. Group A patients given Pneumatic Compression Therapy (PCT) and Manual Lymphatic Drainage (MLD). Group B given Lymphatic Drainage Exercises (LDE) and Manual lymphatic drainage (MLD) and Group C given Manual lymphatic drainage (MLD) for lower limb lymph edema. All three groups were treated for four weeks.Results: The age, weight and height of subjects in groups A, B and C were compared by using analysis of variance. There was no significant difference found in age, weight and height in all 3 groups (P>0.05). But significant difference found at 3 to 4 weeks in all 3 groups. (P

ObjectivesTo explore men´s onset and burden of lower limb lymphedema (LLL) after radical prostatectomy (RP) with pelvic lymph node dissection.Patients and methodsA cross-sectional survey-based study was conducted nation-wide and web-based in Germany. Part 1 included 15 multidisciplinary compiled questions with three questions from Short Form 12 Health Survey (SF-12) and WHO activity recommendation, part 2 the validated German Lymph-ICF-Questionnaire (Lymph-ICF-LL). Subgroup comparisons and simple regression analyses were used to identify factors associated with therapy and burden of LLL, followed by multiple regression analyses to explain variance in impairment in the patients’ daily life.Results54 patients completed the survey. Median time of LLL-onset was reported with 2.0 (0.5-9.75) months after RP. 19 patients (35.2%) reported bilateral lymphedema, 28 (51.9%) the use of individually fitted compression stockings (CS), 25 (46.3%) of manual lymphatic drainage (LD) and 26 (48.1%) complete regression.The Lymph-ICF-LL revealed a higher total burden for patients with an active LLL compared to complete regression (total score: 25.5 vs. 11.9, p=0.01) specially for “physical function” (28.3 vs. 12.9, p=0.004) and “mental function” (26.2 vs. 6.7, pConclusionMen with LLL after RP with PLND report a significant burden in daily life. Bbasic therapy needs to be offered early. Postoperative onset of LLL is variable, which should be considered when assessing complications after RP.

Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35‐year‐old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.

Background/aim Upper limb breast cancer-related lymphedema (BCRL) is a chronic and severe condition affecting a significant percentage of breast cancer survivors. Even though its physiopathology is well-known, there is no worldwide consensus on BCRL evaluation and a gold-standard treatment. This narrative review aims at providing a brief descriptive overview with regard to BCRL treatment modalities. Materials and methods We conducted a literature search within the PubMed database, and 33 articles out of 56 were selected, including reviews, systematic reviews, and meta-analyses aiming find the most updated evidence regarding BCRL treatment modalities. Results Physical exercise (aerobic exercise, resistance exercise, aquatic therapy), bandages, and intermittent pneumatic compression were shown to be most effective in BCRL patients, in terms of swelling reduction in the acute-intensive phase. Furthermore, physical exercise was beneficial also as a maintenance tool. Manual lymphatic drainage demonstrated efficacy in preventing secondary lymphedema if applied immediately after breast cancer surgery or in early phases of BCRL or as a maintenance tool. Complementary procedures such as acupuncture, reflexology, yoga and photo-biomodulation therapy did not show conclusive results in BCRL treatment. Surgery was shown effective in managing symptoms (liposuction), preventing (lymphaticovenular anastomosis) and treating BCRL (vascularized lymph node transfer). Conclusion BCRL is still a challenging condition either for breast cancer survivors and clinicians, deeply impacting patient functioning and quality of life. Due to the lack of globally accepted criteria in evaluating BCRL, to date a gold standard treatment for this widespread issue is still needed.

Female patients suffer from the risk of upper limb lymphedema after breast cancer removal surgery. At present, the detection and the adjuvant treatment of this disease are not convenient enough, leading to delay of the disease and increase in the burden of patients. This paper presents a portable monitoring and treatment device for upper extremity lymphedema, enabling patients to monitor the symptoms of upper limb lymphedema and auxiliary rehabilitation. This design utilizes the arm circumference measurement and contrast method to realize symptom monitoring. The device realizes auxiliary rehabilitation using the regional pressure method to imitate traditional manual lymphatic drainage technology. According to the MRI images of volunteers’ upper limbs, the upper arm and forearm’s finite element models are reconstructed in ANSYS. The static simulation experiment is completed. The working mode and parameter design of each rehabilitation module of the device are obtained. The experimental results show that the integrated design principle of monitoring and treatment proposed in this paper has good feasibility, has auxiliary rehabilitation effect, and meets the principle of human comfort. The device can help patients find lymphedema in time and implement auxiliary treatment, which can effectively avoid the further deterioration of lymphedema.

Simple Summary Lymphedema is a chronic, debilitating disease of the lymphatic vasculature. Although several reviews focus on the anatomy and physiology of the lymphatic system, this review provides an overview of the lymphatic vasculature and, moreover, of lymphatic system dysfunction and lymphedema. Further, we aim at advancing the knowledge in the area of lymphatic system function and how dysfunction of the lymphatic system—as seen in lymphedema—affects physiological systems, such as the cardiovascular system, and how those might be modulated by lymphedema therapy. Abstract This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

Background. There are many opinions and views regarding the methods of treatment of patellar ligament enthesopathy. No gold standard of treatment exists. This paper presents our approach involving conservative treatment and an appropriate rehabilitation regime. Our aim was to assess the effectiveness of a combination of various conservative treatment techniques and the time needed to return to sport. Material and methods. The study enrolled 14 patients treated in 2019 and 2020. Knee joint evaluation was based on clinical and radiological examination (sonography and MR). All patients were treated conservatively according to a specially prepared treatment protocol. Patients were evaluated at two-week intervals until the symptoms subsided completely. The KOOS, Kujala and SF36 questionnaires were used to evaluate the results. Results. All of the patients returned to painless physical activity within 3-4 weeks from the start of treatment. In the group of professional athletes, 100% returned to sport. The return to sport took slightly longer for pa­tients with bilateral (5-6 weeks) in comparison to unilateral jumper’s knee (3-4 weeks). The longest period of return to sport, in a patient who had severe pain at rest before starting treatment, was 7 weeks. Statistically significant improvement was noted in all of the questionnaires used and in all subdomains at 6 months after the beginning of the treatment. Conclusions. 1. The conservative approach proposed by us generated promising results in the treatment of the jumper’s knee. 2. A 100% rate of return to sport was recorded among our patients.

Cellulite is one of the complications post liposuction. Cellulite causes changes in the lymphatic system. Manual lymphatic drainage is utilized as an effective treatment for enhancing cellulite.To compare between Vodder Manual Lymphatic Drainage (MLD) Technique andThirty female patients with cellulite grade 3 after thigh liposuction participated in the study, and they were randomly divided into two equal groups: Group (A) that received Vodder MLD Technique and Bandage and Group (B) that received Casley-Smith MLD Technique and Bandage. The duration of the intervention was 8 weeks per participant, and each participant received 3 sessions per week.The results revealed that there was a significant improvement in both groups by using two different methods of treatment (Both Vodder technique and Casley-Smith technique are effective in treatment of cellulite after thigh liposuction but there is no difference between them, hence any technique of MLD is recommended to achieve better improvement in this case.

Objective: In recent years, there have been only a few studies showing an improvement of the lymphatic system function in patients with abnormal body weight after the use of manual lymphatic drainage (MLD). The aim of the study was to assess the effectiveness of using MLD of the abdominal cavity as one of the forms of therapy for lymphatic system dysfunction in people with abnormal body weight. Material and methods: The study presents the therapy of two women aged 30 to 59. They underwent 10 treatments of manual lymphatic drainage of the abdominal cavity (30 minutes x 3 times a week). Biochemical tests were performed before and after the MLD treatment. The degree of obesity was determined on the basis of the BMI (body mass index) and WHR (waist-to-hip ratio). The 7-point Likert scale was used to evaluate the patients’ quality of life. Results: The overweight patient showed an improvement in biochemical parameters, including a decrease in the level of C-peptide and C-reactive protein, and a better quality of life compared to the state before the therapy. This subject scored 3 points before vs. 5 points after the MLD treatment. The patient with class 2 obesity and comorbidities showed no improvement in biochemical parameters, however, there was a change for better in the quality of life after the therapy. The patient scored 3 points before vs. 4 points after the MLD treatment. Conclusions: Preliminary studies indicate potential benefits of using MLD for improving biochemical parameters, including a reduction of inflammation in an overweight patient.

Objective: To assess whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment. Study Design: Randomized, non-inferiority, controlled study to compare the efficacy of three physical therapies’ regimens in the Decongestive Lymphatic Therapy. Participants: 194 lymphedema patients, stage II–III with excess volume > 10% were stratified within upper and lower limb and then randomized to one of the three treatment groups. Baseline characteristics were comparable between the groups. Intervention: all patients were prescribed 20 sessions of the following regimens: Group A (control group): manual lymphatic drainage + Intermittent Pneumatic Compression + Bandages; Group B: pneumatic lymphatic drainage + Intermittent Pneumatic Compression + Bandages; and Group C: only Intermittent Pneumatic Compression + Bandages. End-point: Percentage reduction in excess volume (PREV). Results: All patients improved after treatment. Global mean of PREV was 63.9%, without significant differences between the groups. The lower confidence interval of the mean difference in PREV between group B and group A, and between group C and group A were below 15%, thus meeting the non-inferiority criterion. Most frequent adverse events were discomfort and lymphangitis, without differences between groups. A greater baseline edema, an upper-limb lymphedema and a history of dermatolymphangitis were independent predictive factors of worse response in the multivariate analysis. Conclusions: Decongestive lymphatic therapy performed only with intermittent pneumatic compression plus bandages is not inferior to the traditional trimodal therapy with manual lymphatic drainage. This approach did not increase adverse events.