Assessing the effectiveness of multilayer inelastic bandaging
<p>Multilayer inelastic lymphoedema bandaging (MLLB) applied with a pressure of >45mmHg is the standard intensive treatment for severe forms of lymphoedema. MLLB consists not only of several layers but also of different single components whose elastic properties may vary. The combination of these layers leads to a change in the elastic property of the final […]
More than ‘a bit of swelling’: living with lymphoedema
<p>Many patients are told by their doctors that lymphoedema is ‘just a bit of swelling’. The onset of lymphoedema after cancer treatment can be a devastating experience for many patients and is often viewed as the ‘final straw’. The psychological impact can be immense as patients struggle with feelings of isolation, altered body image and […]
Education: building on the past and preparing for the future
<p>This paper considers issues relevant to lymphoedema education from both the provider and participant perspectives. Current education in the UK is based on a model developed by the British Lymphology Society (BLS), which identifies four groups of patients with differing needs. Application and continued relevance of this approach is discussed in light of the introduction […]
Israeli Lymphedema Association
<p>In November 2004, as a result of meetings and discussions held over 10 years, the Israeli Lymphedema Association (ILA) was established by the Tel Aviv Lymphedema Patients’ Support Group, and registered in Israel. The ILA is a non-profit organisation that promotes knowledge and increases awareness about lymphoedema among patients and healthcare professionals in Israel. The […]
The use of lymphoscintigraphy in the management of chronic oedema
<p>Lymphoscintigraphy is widely considered to be the main investigation to establish the diagnosis of lymphoedema and visualise peripheral lymphatics. However, there is no internationally agreed standardised technique. This article considers technical aspects of lymphoscintigraphy (radiotracers used, sites of injection, qualitative and quantitative methods and the sensitivity and specificity of the technique) and its clinical application, […]
Impact of implementation intentions on exercise adherence
<p>Background: Particpants (n=72) were recruited from four service user support groups in the United Kingdom to take part in a prospective, longitudinal study on exercises undertaken as part of a self-care programme. Aims: To investigate participants’ knowledge and beliefs about a lymphoedema exercise programme and examine the impact of an intervention involving the formation of […]
A rare case of Kaposi sarcoma
<p>Classic Kaposi sarcoma (KS) is a rare type of cancer that develops in endothelial cells in the skin. This unusual neoplastic disorder was first described by Moritz Kaposi in 1872. It is predominantly found in men between the ages of 50 and 80 who are of Mediterranean ancestry. The incidence of classic Kaposi sarcoma in […]
Understanding lymphoedema in the new millenium
<p>We face three major issues in lymphoedema management: reducing the risk of secondary lymphoedema; early detection; and providing solid evidence for the management and treatment of patients. We have seen advancements in our understanding of lymphoedema at the genetic, molecular, cellular and tissue level, helping us to understand that more than just a damaged lymphatic […]
Multidisciplinary guidelines for early diagnosis and management
<p>In 1999, the Dutch Institute for Healthcare Improvement (CBO) organised a task force on lymphoedema to evaluate the current literature and to propose evidence- and expert-based recommendations suitable for the national implementation of guidelines for the treatment of lymphoedema. Representatives from national medical scientific organisations (e.g. surgery, gynaecology, radiotherapy, dermatology, and others), paramedical associations and […]
To measure or not to measure? What and when is the question
<p>Measuring limbs and noting patients reports tells us about the effects of a disrupted lymphatic system not about changes to lymphatic function. To know something of the latter, the only option is lymphoscintigraphy. Each measurement we make adds something to our knowledge and we must continue to measure as we think best, according to the […]
An unusual case of primary lymphoedema praecox
<p>Primary lymphoedema praecox is a condition that predominantly affects women and involves swelling in one or more limbs which may extend to the trunk (Browse, 2003). The swelling usually occurs before the age of 35 years and most commonly presents during puberty. There does not have to be a family history of the condition, but […]
Lymphoedema management in India
<p>This article focuses on the management of secondary lymphoedema caused by lymphatic filariasis (LF) in India. LF is a parasitic infection spread by mosquitoes. The infection, which is caused by thread-like parasitic worms (<em>Wuchereria bancrofti</em> or <em>Brugia malayi</em>) that damage the human lymphatic system, is usually contracted in childhood, often before the age of five […]
Comparison of the effectiveness of MLD and LPG technique®
<p>Background: This study compares Endermologie® — a new treatment for lymphoedema which involves mechanised massage — with manual lymphatic drainage (MLD).</p>n<p>Methods: A single-blinded, randomised study compared the two techniques combined with compression bandaging to treat secondary arm lymphoedema post breast cancer treatment. The MLD group (<em>n</em>=20) and the Endermologie group (<em>n</em>=10) received treatment four times […]
Society update Vol 1, No 1
<p>An update from societies including British Lymphology Society, Lymphoedema Association of Australia, Dutch Lymphoedema Network, Society of German-speaking Lymphologists, German Society of Lymphology, Lindsay Leg Club, Lymphoedema Support Network, Leg Ulcer Forum, Svenska Ödem Förbundet , and National Lymphedema Network.</p>
A rare case of post-mastectomy lymphangiosarcoma
<p>Lymphangiosarcoma or Stewar t- Treves syndrome is a rare and aggressive malignancy of the lymphatic vessels. It was first described as arising in chronically lymphoedematous extremities by Stewar t and Treves (1948), who noted the condition in six females who had undergone radical mastectomy for breast carcinoma. Since this time, over 300 cases of lymphangiosarcoma […]
Society update Vol 2, No 2
<p>Updates from:</p>n<ul>n<li>The British Lymphology Society (BLS)</li>n<li>The Lymphoedema Association of Australia (LAA)</li>n<li>The Swedish Society of Lymphology (Svensk Förening för Lymfologi)</li>n<li>The Leg Club</li>n<li>The German Society of Lymphology</li>n<li>The National Lymphedema Network (NLN)</li>n<li>The Lymphoedema Support Network (LSN)</li>n<li>The Australasian Lymphology Association (ALA)</li>n<li>The Dutch Lymphedema Network (NLNet)</li>n</ul>
Lymphoedema Support Network: a short history
<p>The Lymphoedema Support Network (LSN) is the only national patient-led organisation that supports people with lymphoedema by providing clear information about the condition and encouraging a nationwide network of support groups. From its beginnings in 1991, it has fought to raise awareness of the condition in parliament, in hospitals and in primary care. It remains […]
Society update Vol 2, No 1
<p>- The British Lymphology Society (BLS) – The Lymphoedema Association of Australia – The Swedish Society of Lymphology (Svensk Förening för Lymfologi) – The Leg Club® – The German Society of Lymphology – Israel Lymphedema Association (ILA) – The Lymphoedema Support Network (LSN) – MLD UK – The Australasian Lymphology Association (ALA) – The National […]
A reflection on a young life with lymphoedema
<p>As the mother of a young person with lymphoedema, I have often reflected on the life of my child and how the condition has affected our family. This article is the first time those thoughts have been articulated to a wider audience, and my purpose is to reflect on the experience for the benefit of […]
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 […]
Palliative bandaging in breast cancer-related arm oedema
<p>Palliative bandaging is used in patients with arm oedema for whom conventional intensive treatment is not possible nor appropriate, e.g. because of their general condition or local disease. A variety of palliative bandaging techniques to suit different circumstances is described. Contraindications and cautions are discussed. Palliative bandaging should be carried out by healthcare professionals who […]
Progress of prevention and treatment in China
<p>Worldwide, 140–250 million cases of lymphoedema are estimated to exist, with filariasis being the most common cause (Miller, 1998). Until now, there has been no precise estimation of the incidence of the disease in China. Fifty years ago, filarial lymphoedema was the most common variation of the disease. China was one of the most seriously […]
Women at work with breast cancer-related lymphoedema
<p>Background: Little attention has been given to the impact of lymphoedema on breast cancer survivors’ work experience.</p>n<p>Aims: To describe the experience of work of breast cancer survivors with lymphoedema. Methods: A descriptive phenomenological method was used. Sixty-six in-depth interviews were completed with 22 participants in the United States.</p>n<p>Results: Three essential themes illuminating the meaning of […]
A review of the epidemiology of BCRL
<p>Problems exist in all studies in relation to the epidemiology of breast cancer-related lymphoedema (BCRL). However, the evidence suggests that lymphoedema occurs in approximately one-quarter to one-third of patients who have undergone surgery for breast cancer. Factors which appear to predispose patients include: use of irradiation; extent of axillary node dissection; combined axillary surgery and […]
Bioimpedance analysis in the assessment of lymphoedema diagnosis and management
<p>Lymphoedema can pose diagnostic challenges, particularly in its early stages. Conventional assessment measures suffer from varying degrees of invasiveness and imprecision. In this context, the potential current and future applicability of multifrequency bioimpedance analysis (MFBIA) is discussed. This accurate, reproducible and non-invasive method detects alterations in extracellular fluid volume and is applicable to both unilateral […]
Lymphoedema management in the context of poverty alleviation
<p>Pover ty alleviation is one of the major shared international objectives of all the United Nations agencies, such as the World Health Organization (WHO) and the World Bank, and health impairments (blindness, impairment of manual dexterity or the ability to walk), must be better managed, not least because they are a major contributor to pover […]
A framework for global collaboration and best practice
<p>It is well recognised that international collaboration is essential if lymphoedema of all causes and in all its various presentations is to be recognised, treated, managed and indeed prevented effectively. A quick look through each issue of this journal since its launch in 2006, shows this to be a consistent message. In the area of […]
Breast and trunk oedema after treatment for breast cancer
<p>Breast and trunk oedema can occur with or without arm lymphoedema following breast cancer treatment and are often dismissed as common side-effects that will resolve. This paper discusses relevant epidemiology, explores the impact on patients and discusses assessment and management approaches including manual lymph drainage (MLD), compression therapy and Kinesio Taping methods. A number of […]
Perspectives of elephantiasis in an endemic area of Brazil
<p>Background: The most advanced form of lymphoedema, known as elephantiasis, is one of the most distressing clinical presentations of lymphatic filariasis. Aims: The objective of this study was to explore women’s experiences of elephantiasis. Methods: This study was conducted at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF) in Recife, Brazil. […]
Liposuction versus conservative treatments?
<p>Lymphoedema maintenance therapy is timeconsuming, laborious, and associated with diminished quality of life (QoL) (Cheville, 2002). Patients are understandably eager for discrete treatments that can permanently improve their condition and replace the unwelcome daily ritual of bandaging and garment use? Over the past decade, liposuction has hinted at such a promise; a one-time procedure that […]
Lymphatic system function and obesity — are there links?
<p>The work of Natasha Harvey et al in 2005 showed a strong link between lymphatic vascular defects and adult onset obesity (in mice), and Schneider et al (2005) commented that this, and other research, raised the spectre of significant involvement of the lymphatic system and its functioning (or more properly its inability to function well) […]
Patients will benefit from stronger interdisciplinary links
<p>For the majority of healthcare specialists in the UK, life is often hectic and working through lengthy to-do lists more than fills the hours in each day. As a result of this we can sometimes become immersed in our own worlds, focused on meeting the clinical challenges directly in front of us and becoming detached […]
Prophylactic antibiotics for the prevention of cellulitis
<p>Background: Cellulitis of the lower leg accounts for 2–3% of hospital admissions (Cox et al, 1998), with an average length of in-patient stay of nine days. Studies have reported that up to half of these patients suffer further episodes (Cox et al, 1998; Dupuy et al, 1999). Reducing the recurrence of cellulitis could therefore have […]
Global teamwork is key for treating complex disorders
<p>There appears to be a growing acknowledgement that lymphoedema is an important healthcare issue in all countries of the world. In the UK, the work of the Lymphoedema Framework Project (LFP) with its partnership approach, has led to increasing awareness of the size and complexity of the problem and has attracted interest from the Department […]
Achieving consensus in lymphoedema care
<p>The Lymphoedema Framework Project is a national initiative aimed at developing and evaluating integrated, primary care-based, specialist-led lymphoedema services in a number of participating primary care trusts around the country. The aims of the project are to make available appropriate care to patients no matter what the cause of their lymphoedema, and to raise the […]
Global collaboration is crucial for lymphology and filariology
<p>‘New trial with antibiotics brings hope to elephantiasis sufferers’ declared a recent press release from a prominent university in the UK. Researchers reported that lymphoedema stage (but not limb circumference or the incidence of acute inflammatory episodes) had been significantly reduced in eight patients from a filariasis-endemic area of Ghana one year after a six-week […]
Using the evidence we have to inform best practice
<p>Management of disease must be undertaken using the best available evidence. The development of clinical guidelines is seen as a major contribution to improving care, though how evidence is selected and used has in the past often been on an ad hoc basis. The ideal guideline should be based on systematic reviews, which examine the […]
Does breathing have an influence on lymphatic drainage?
<p>Changes are caused to the intra-thoracic and intra-abdominal cavity pressures as we breathe, even when we breathe superficially, but especially with deep abdominal breathing. As the tidal volume increases, the diaphragmatic excursion will increase, causing a greater change in pressure in the thoracic and abdominal cavities, which is particularly pronounced with increased respiratory rate. Within […]
Can we prevent the development of lymphoedema?
<p>The focus of this debate is the prevention of the development of overt, clinical lymphoedema in those at risk. Much of the literature has concentrated on reducing the risk of lymphoedema development after treatment for breast cancer. Some of this has related to refinements in surgical and radiotherapy techniques, such as sentinel node biopsy (Sener […]
Lymphatic filariasis and the role of nursing interventions
<p>Lymphoedema in the resource rich countries of the world is usually associated with cancer or venous disease. In the developing world, however, large numbers of people (1.2 billion) (Dean, 2001) are at risk of developing lympoedema because they live in areas where the infected mosquitos take frequent blood meals from humans. This article seeks to […]
Lymphoedema steps into the healthcare spotlight
<p>We are delighted to welcome you to the first issue of the Journal of Lymphoedema. The journal has been produced in partnership with the Lymphoedema Framework Project (LFP) and Wounds UK. The LFP is a UK-based research collaboration that involves lymphoedema specialists from the British Lymphology Society (BLS), organisations responsible for care delivery, researchers and […]
A history of the Dutch lymphoedema network
<p>The Lymphedema Group Drachten was founded in 1995 in the Nij Smellinghe Hospital in Drachten, the Netherlands, to diagnose and treat patients. The Dutch Lymphology Foundation (Stichting Lymfologie Centrum Nederland, SLCN) was founded in 1998 to disseminate knowledge and experience to those working in this field and started an internet platform called The Lymphedema Network. […]
Making a case for funding for lymphoedema services
<p>Background: Lymphoedema is a chronic condition which has a significant impact on the lives of sufferers. Services for lymphoedema management are not standard throughout the UK. Recently a request for funding of lymphoedema services in Fife required the creation of a needs assessment.</p>n<p>Aims: The study aim was to establish whether or not lymphoedema presents a […]
A new anti-biofilm Hydrofiber® dressing: in vitro determination of microbial kill rate in biofilms
<p>Biofilm bacteria counts of potential wound pathogens fell below the limit of detection within 48 hours for the AQUACEL® Ag+ dressing. Approximately an 8 log reduction (100 million-fold) reduction in biofilm bacteria was achieved for each challenge organism for the AQUACEL® Ag+ dressing. A >3 log reduction was achieved within 4 hours for S. aureus […]
A clinical evaluation of AQUACEL® Ag Extra™ dressings in the management of patients with infected diabetic foot ulceration
<p>The aim of this poster is to illustrate effective anti-microbial and exudate management, in diabetic foot ulceration by the use of AQUACEL® Ag Extra™ dressings as part of the management plan.</p>
A new anti-biofilm Hydrofiber® dressing: demonstration of enhanced silver penetration and biofilm removal in vitro
<p>Biofilm treated with anti-biofilm Hydrofiber dressing 2.6 times the amount of silver as biofilm treated with SHF. When the lower residual mass is taken into account, the concentration of silver in the biofilm is 4 times greater. These assays suggest that AQUACEL® Ag+ will be significantly better than the existing AQUACEL® and AQUACEL® Ag dressings […]
