The facts about liposuction as a treatment for lymphoedema
<p>There is some controversy regarding liposuction for late-stage lymphoedemas. While it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used […]
Lymphoedema and sexual relationships in mid/later life
<p>Background: Women with breast cancer-related lymphoedema (LE) can experience physical, psychological, and sexual problems as a result of both physical limitations and appearance associated with this condition. Aims: This study investigated the effect on quality of life of the sexual relationships with intimate partners for women with LE. Methods: Participants were 11 women with LE. […]
An overview of lower limb lymphoedema and diabetes
<p>The prevalence for individuals diagnosed with lower limb lymphoedema and coexisting diabetes is unknown. However, both conditions cause significant problems that can compromise the viability of the lower limbs. An extensive search of the literature including medical databases (MEDLINE, PubMed and CINAHL), plus hand searching through diabetes journals, podiatry journals and wound care journals, was […]
BCRL questionnaires: climate and indigenous groups
<p>Valid and reliable subjective questionnaires are essential to enable research regarding the effect of breast cancer-related lymphoedema (BCRL) on quality of life (QoL). This review was undertaken to determine the reliability and validity of four current subjective questionnaires for the evaluation of BCRL, particularly with respect to climate and ethnic or indigenous groups. Searches were […]
Audit of the use of kinesiology tape for breast oedema
<p>Background: Lymphoedema developing in the breast and truncal area after treatment for breast cancer can be challenging to manage and distressing for patients. Kinesiology tape has traditionally been used in sports injuries and is considered effective at improving lymph drainage (Kase et al, 2003). It offers potential as a self-care option for managing swelling in […]
A new treatment for soft tissue fibrosis in the breast
<p>Background: Soft tissue fibrosis is a common consequence of breast cancer treatment and chronic lymphoedema. It can compromise function and quality of life, but research regarding interventions is limited.</p>n<p>Aims: To assess the efficacy of using JoViPitPak® (JoviPak Corporation) to influence soft tissue fibrosis change by looking at tissue density, perceived cosmesis and perceived breast pain.</p>n<p>Methods: […]
Using honey in post-excision malignant melanoma ulcers
<p>Malignant melanomas are extremely difficult to treat conservatively at primary care level since the precise diagnosis requires a skin biopsy, which then undergoes dermatoscopy or epiluminescence microscopy. The treatment also varies according to the stage of melanoma and whether it is a superficial spreading melanoma or a melanoma in situ (Lorentzen et al, 1999). For […]
Lymphoedema prevalence in the West Midlands region
<p>A report was produced, focusing on the overall prevalence of lymphoedema in the West Midlands region with further analysis relating to diagnosis, caseload gender, average caseload, and staffing levels. The information was provided by 43% of British Lymphology Society members in the West Midlands between May and June 2012. However, the figures were affected by […]
A rare case of lymphoedema-distichiasis
<p>Lymphoedema-distichiasis is a rare autosomal-dominant condition characterised by a second row of eye lashes (distichiasis) and pubertal onset of lower limb lymphoedema. It was first described in 1964 by Falls and Kertesz, but it took almost 40 years for the gene that causes the condition to be located on chromosome 16 (Fang et al, 2000). […]
Society update Vol 3, No 2
<p>- British Lymphology Society – The Australasian Lymphology Association (ALA) – The International Society of Lymphology – Leg Club – The Japanese Society of Lymphology – The National Lymphedema Network (NLN) – The Lymphoedema Support Network – The Israel Lymphedema Association (ILA)</p>
Lymphoedema is part of who I am
<p>In 1999, when I was 19 years old and in my second year of university, I remember standing in the living room saying to my housemates, ‘Do my legs look swollen to you?’ They agreed they did look a little swollen but we did not know why, so left it there. A few months later […]
Use and response to treatment using low level laser therapy
<p>Laser therapy for lymphoedema treatment has been used internationally for many years but has been slow to be accepted in the UK. The science behind the technique and its effectiveness in reducing fluid viscosity and encouraging motoricity of the lymphatics has been reported (Lievens, 1987; Eliska and Eliskova, 1997). The evaluation reported in this paper […]
Klippel-Trenaunay-Weber syndrome — a case report
<p>Klippel-Trenaunay-Weber syndrome is a rare congenital syndrome involving enlarged veins and arteries, limb hypertrophy and capillary malformations. In 1900, French physicians, Klippel and Trenaunay, first described what became known as Klippel-Trenaunay syndrome after two patients presented with a triad of symptoms — port-wine stain, varicose veins, and bony and soft tissue hypertrophy involving an extremity […]
Role of GPs in breast cancer-related arm morbidity care
<p>Background: This paper addresses a gap in the literature on breast cancer-related arm morbidity care regarding clinician responsibility for the management of women’s treatment-related arm morbidity needs. Using a qualitative research method, the authors spoke to general practitioners (GPs) about their perceptions, knowledge and experiences of breast cancer-related arm morbidity, and what role, if any, […]
Human functioning in lymphoedema
<p>Background: The description and testing of the different levels of human functioning is essential prior to beginning the treatment of patients with lymphoedema.</p>n<p>Aims: The International Classification of Functioning, Disability and Health (ICF) offers an international framework for the classification of health and health-related domains. ICF Core Sets are lists of selected ICF categories concerning the […]
Clinical effectiveness and patient considerations in oedema management
<p>This article aims to strike a balance between compression bandaging to treat oedema and a positive patient experience. Compression therapy is well recognised as a key component in the management of venous and lymphatic conditions. Science indicates that intermittent pressures provided by inelastic bandage systems rhythmically stimulate venous and lymphatic flow to reduce and contain […]
Myiasis in a bancroftian filariasis endemic area
<p>Background: Human myiasis in bancroftian filariasis endemic areas, although rarely reported in the literature, might pose an important aggravating factor for patients with swollen limbs with wounds, such as varicose ulcers and mossy lesions (lymphangiomatosis).</p>n<p>Aims: To study the occurrence, clinical and parasitological characteristics of wound myiasis in individuals living in a filariasis endemic area in […]
Use of a Velcro® wrap system in the management of lower limb lymphoedema/chronic oedema
<p>Lymphoedema and chronic lower limb oedema are conventionally treated with multi-layer bandaging, followed by compression hosiery. Inevitably, this management system can be difficult to maintain in some patients, especially those with hand weakness, back problems, obesity, or those who are elderly, have abnormal limb shapes or are palliative patients. Farrow Wrap™, a Velcro® wrap system, […]
Mapping of lymphatic filariasis in Rwanda
<p>Background: Infections with Wuchereria bancrofti causing lymphatic filariasis (LF) still represent one of the major health problems in the tropics. In Rwanda, where LF has been considered endemic by the World Health Organization (WHO) and the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), there are no reliable data on distribution and prevalence of the disease. […]
Is BIS ready for prime time as the gold standard measure?
<p>Assessment of lymphoedema can pose challenges to the clinician. There is no universally accepted standardised method for measurement. In this, the first of two articles, Leigh Ward, a pioneer in the application of bioelectrical impedance spectroscopy (BIS) for assessment of breast cancer-related lymphoedema, makes a strong case that BIS technology now warrants consideration as the […]
A quality of life measure for limb lymphoedema (LYMQOL)
<p>Background: This paper describes the validation of a ‘condition-specific’ quality of life (QoL) assessment tool for lymphoedema of the limbs (LYMQOL). Aims: To ascertain whether the tool could accurately assess QoL in this patient group. Methods: Face and content validity were assessed by patient questionnaires; criterion validity by comparison with European Organisation for Research and […]
Is there a role for contrast hydrotherapy?
<p>Contrast hydrotherapy involves the immersion or dousing of a limb in alternating hot and cold water. This ‘tweaks’ the peripheral autonomic nervous system, altering vascular tone and flow and improving nitric oxide production and vessel health. It has been shown (Elmstahl et al, 1995; Fiscus et al, 2005) to improve both short- and long-term distal […]
A shift to chronic disease care management
<p>Lymphoedema is a chronic medical condition which may reduce a person’s quality of life by negatively impacting on his or her medical, physical, psychosocial and functional status. This article argues that lymphoedema progression can be more effectively controlled by focusing clinical care delivery on client self-management, to better address the possible complications of this condition, […]
Relationship between pain, tightness, heaviness, perceived limb size, and objective limb size measurements in patients with chronic upper-limb lymphoedema
<p>Background: Lymphoedema has a significant effect on patient quality of life due to the daily experience of limb symptoms such as pain, tightness and heaviness. While treatment of lymphoedema often focuses on reduction in objective limb measures, there is minimal evidence to support that this reduces subjective limb symptoms.</p>n<p>Aims: This study aimed to investigate the […]
National Lymphedema Network
<p>In 1988 the National Lymphedema Network® (NLN®) was established by Saskia RJ Thiadens, in response to a growing need for awareness, education and, most importantly, an effective treatment for lymphoedema. Recognised both nationally and internationally, the NLN is a California-based 501(c)3 nonprofit organisation dedicated to diminishing the suffering of lymphoedema patients through education, service and […]
Holistic management of lymphoedema in Japan: two contrasting cases
<p>One of the roles of a nurse is to keep patients with secondary lymphoedema from breast cancer treatment motivated to self-care, as its symptoms are chronic and debilitating. Patients need an easy, quick, cheap, and effective self-care programme because they often cannot and do not adhere to complex, timeconsuming, and expensive treatments. The author’s clinic […]
Early detection — a strategy to reduce risk and severity?
<p>Despite changes in surgical techniques, radiotherapy targeting and the apparent earlier detection of cancers, secondary lymphoedema is still a significant problem for about 20–30% of those who receive treatment for cancer, although the incidence and prevalence does seem to be falling. The figures above generally relate to detection of an enlarged limb or other area, […]
ALFP: identifying issues in lymphoedema in the US
<p>The American Lymphedema Framework Project (ALFP) is a national initiative introduced in 2008 to improve the management of lymphoedema (LE) and related disorders in the United States. A National Stakeholders Conference was held in March 2009 to share perspectives on the current state of LE, establish priority issues, and recommend actions to move the field […]
I underwent liposuction to reduce the volume in my leg
<p>I first developed primary lymphoedema ten years ago. I woke up one morning to feel my right leg tight and slightly swollen. I could not recall being bitten or anything untoward and decided it would go away of its own accord. How wrong was I to be proved.</p>
Use of Juxta-Fit™ to reduce oedema and promote self-management
<p>This article looks at three case reports which show the clinical effects of the inelastic, adjustable device, Juxta-Fit™(medi UK). This device allows patients to be self-caring and independent. It is also effective in reducing the volume of the lymphoedematous limb and as maintenance therapy following decongestive lymphatic therapy (DLT). Juxta-Fit can be used as a […]
Lymphoedema associated with sirolimus treatment
<p>Background: Secondary lymphoedema is a chronic condition that has a financial, emotional and physical impact and causes a decrease in quality of life for affected patients. Twenty cases of lymphoedema presenting in patients undergoing sirolimus immunosuppresive therapy, for renal or hepatic transplantation, have been reported since 2004. Although some patients showed a marked improvement after […]
Introducing a skin cancer lymphoedema prevention and rehabilitation scheme
<p>Lymphoedema is an incurable, progressive chronic condition and unfortunately it is a potential complication of the treatment for malignant melanoma following axillary node dissection and groin dissection. Referrals for this user group is ever-increasing to the Abertawe Bro Morgannwg University Health Board clinic presenting with established swelling, poor skin condition, and decreased range of movement. […]
Society update Vol 3, No 1
<p>Highlights from lymphology societies around the world.</p>
Selected abstracts from the BLS annual conference 2008
<p>The British Lymphology Society Research Advisory Board (BLS RAB) is pleased that the Journal of Lymphoedema has agreed to publish the following selected abstracts from last year’s conference in Belfast. We would like to encourage members and other healthcare professionals to submit abstracts for this year’s conference to be held in Sheffield. Details of the […]
Society update Vol 4, No 1
<p>- British Lymphology Society – The Lymphoedema Association of Australia (LAA) – The International Society of Lymphology – The Japanese Society of Lymphology – National Lymphedema Network – The Lymphoedema Support Network – The Dutch Lymphedema Network (NLNet) – The German Society of Lymphology – The Lymphology Association of North America (LANA) – Leg Club […]
Finding my ‘new normal’ by self-empowerment and self-care
<p>My personal journey with lymphoedema has been a rocky road, filled with misinformation from various healthcare professionals. I hope that no other patients have to go through the distress I went through in getting a diagnosis and finding an appropriately qualified lymphoedema therapist and treatment.</p>
Lymphoedema management in Spain
<p>In the 1980s, as a result of the work of a group of vascular surgeons, including Dr Azcona and Dr Jimenez-Cossio who founded the Club of Lymphology (a group of doctors interested in the study of lymphatics and lymphoedema) and Dr Samaniego, who was the first to perform venous-lymphatic anastomoses in Spain, lymphoedema began to […]
LE risks, what are they and how can they be reduced?
<p>Lymphoedema can a long-term complication of breast cancer treatment (Mak et al, 2008), which, once established, is difficult to cure. Therefore, it is essential to prevent or minimise this condition. Factors that contribute to the development of breast cancer-related lymphoedema (BCRL) are not as yet fully elucidated. The common procedures of venepuncture and blood pressure […]
Self-management in combating chronic skin disorders
<p>The lymphatic system plays an integral role within the body’s circulatory system. When this fails to work effectively, however, morbidity levels rise for the individual, as does the demand placed on healthcare services. Failure of the lymphatic system leaves individuals with long-term chronic conditions that require regular input from a range of health professionals.</p>
An optical fibre tape sensor for monitoring sub-bandage pressures: Progress towards an “ideal sensor”
<p>A fibre optic sensing array in the form of a thin, flexible tape is described and tested for the monitoring of sub-bandage pressures. The sensing array consists of 36 discrete sensing elements spaced at 1-cm intervals along the tape and provides real-time feedback of applied pressures. It has been used to assist an experienced wound […]
Diagnostic investigations for oedema of the upper limb
<p>Oedema of the upper limb may be attributable to several factors, including malignancy, venous or lymphatic abnormality. This article illustrates the concept of differential diagnosis for lymphoedema, by critically reviewing the diagnostic tests and examinations performed to investigate unilateral arm swelling in a 51-year-old woman. It reveals the pitfalls of using non-standardised diagnostic tests and […]
Drugs that may exacerbate and those used to treat lymphoedema
<p>This article explores the potential for drugs which can cause oedema to exacerbate pre-existing lymphoedema. Guidance on the assessment and management of patients taking these drugs is given. Drugs which may be used to treat lymphoedema are also considered. Current evidence does not support the routine use of benzopyrones, selenium, or diuretics in the management […]
Understanding the impact on patients is crucial for practice
<p>A major theme emerging through this issue of the journal is the impact of lymphoedema on patients, and the failure of healthcare professionals to truly acknowledge this in many aspects of everyday life. Gerusa Dreyer portrays the horrifying experience of infestation with maggots (myiasis) and the humiliation and suffering this leads to. Few healthcare professionals […]
Pain and disability: are we ignoring parts of the picture?
<p>Clinical experience shows us that many of the patients that we see in our clinics present with comorbidities: pain, numbness, a range of motion limitations, reduced joint movement, functional problems, etc. I am part of a group that is conducting a multisite Canadian study, aiming to chart the incidence and course of three types of […]
Klippel-Trenaunay syndrome
<p>Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder of blood and lymphatic vessels that is characterised by a combined vascular malformation of the capillaries, veins and lymphatics, congenital abnormalities, and associated limb hypertrophy. This review provides an overview of the disease with emphasis on the management and underlying aetiology of the syndrome. Management of this […]
An American history of lymphoedema management
<p>'Never doubt that a small, group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.’ These words of Margaret Mead, American anthropologist, are relevant to the history and current state of lymphoedema therapy in the USA. Just as with the history of infantile paralysis, cystic fibrosis and […]
Weight-bearing exercise and its impact on arm lymphoedema
<p>Background: There is conflicting information about whether weight-bearing exercises can make lymphoedema worse. Aims: To evaluate the influence of a programme of weight-bearing exercises on the severity of arm lymphoedema. Methods: Eighteen women with breast cancer-related arm lymphoedema took part in a stepped weight-bearing exercise programme. After each session, perceived exertion was rated on a […]
Self-reported management of breast cancer-related lymphoedema
<p>Background: Improvements in breast cancer treatment and early diagnosis are leading to increasing numbers of breast cancer survivors, many of whom are experiencing upper limb lymphoedema as a post-treatment outcome. Current management techniques of breast cancer-related lymphoedema produce uneven results, signifying a need for research in this area.</p>n<p>Aims: To assess the symptom management practices of […]
Selected abstracts from the BLS annual conference
<p>In recent years the British Lymphology Society (BLS) has been keen to encourage its members to present work at its annual conference, either in the form of a poster or an oral presentation. A growing number of members have taken up this challenge and in the last few years a research advisory board (RAB) has […]
Diagnosing breast cancer-related lymphoedema in the arm
<p>Background: Lymphoedema of the arm may complicate breast cancer treatment, including sentinel lymph node biopsy, but when it is mild it is difficult to detect. This study considers the difficulties of diagnosing mild breast cancer-related lymphoedema particularly in relation to the natural differences between right and left arm volume.</p>n<p>Methods: Arm volume was measured opto-electronically in […]
