Page 23 - VOL 26 N. 72 - 2015

EFFECTIVENESS OF PASSIVE MOVEMENT IN THE VOLUME OF LYMPHEDEMA AND CONSISTENCY REDUCTION
DOMINGOP.1, FERNANDEZS.2,RIOA.3, ANTONS.4,DELLMOI.5
1 Centro Vodder de Fisioterapia, fisioterapia, Madrid (ES); 2 Centro Vodder de Fisioterapia, fisioterapia Madrid (ES); 3 Universidad Europea de Madrid, fisioterapia (ES); 4 Hospital Universitario “La Paz”. Rehabilitación, Madrid, (ES); 5 Universidad Rey Juan Carlos, fisioterapia, Madrid, (ES)
Key words: Lymphedema, passive motion, hyaluronic acid.
Introduction: Hyaluronic acid (HA) macromolecule is related to water retention, interstitium changes and lymphatic system. It is proved that passive movement increases the permeability of the thoracic duct and activates the nitric oxide pathway. It could possibly act as fibroblasts activator and decreases the HA lymphedema (LE).
Objectives: To assess the passive motion as a new tool to optimise the treatment of lymphedema (LE).
Methods: Seven patients with lower limb LE, 4 primary and 3 secondary was evaluated with Therapy A and B. To assess the severity of lymphedema, Grade 1 or Mild (150-400 ml total volume difference), Grade 2 or Moderate (400-700 ml) and Grade 3 or Severe (> 750 ml) were used. The tissue consistency was classified as follows: soft, malleable, slightly malleable, hard and very hard. Perimetry was performed and the volume was calculated by the cylinder`s mathematical formula.
A first shock treatment was performed using manual lymphatic drainage (MLD), compression bandages and exercise during an average of 7, 2 days (Therapy A). At this stage patients suffered from severe LE (6 cases) and mild (1); with a consistency of very hard (3), hard (2), slightly malleable (1) and soft (1).
The same patients were enrolled and underwent a new shock treatment. This consisted of adding to Therapy A, a passive ankle dorsiflexion motion of 25 cycles per minute –Therapy B- (Apparatus designed by Dr.Godoy). All patients presented a severe LE (Grade 3) with hard (5), slightly malleable (1) and soft (1) consistency.
Results: In the first intensive treatment, volume was reduced from an average of 491.3 cm3, representing 29.2%, reducing to a mild LE (1), moderate (1) severe (5). The consistency of edema was modified to hard (3), slightly malleable (1), malleable (2) and soft (1). In the second treatment, the mean reduction of edema was 52,6% and 1.055,5 cm3. The consistency before treatment was hard (5), slightly malleable (1) and soft (1). After treatment it became to malleable (4), soft (3).
The volume reduction was 24,5%, due to adding passive motion to Therapy A for the treatment of lymphedema. The consistency of the edema also improved significantly in the second treatment.
Conclusions: Passive motion benefits the reduction of lymphedema and modifies the tissue consistency.
DEEP INFRARED IMAGING TO IDENTIFY VENOUS IMPAIREMENT AFTER BREAST CANCER SURGERY
BELGRADO J.-P. 1, VANDERMEEREN L. 2, VANKERCKHOVE S. 2, VALSAMIS J.-B. 1, MORAINE J.-J. 1, HERTENS D. 2, CARLY B. 2, LIEBENS F. 2
1 Université libre de Bruxelles - Lymphology Research Unit, Bruxelles (BE); 2 C.H.U. St-Pierre - Lymphology clinic of Brussels (BE)
Introduction: Breast cancer related lymphedema (BCRL) is commonly attributed to the axillary lymph node dissection (ALND), with as consequence the reduction of lymph flow transport capacity. Scar adherences, adjuvant therapy, radiation and chemotherapy are widely accepted by the scientific community as aggravating factors for the risk of developing BCRL.
Other parameters seems to contribute also to BCRL. One of these parameters is the change in hemodynamics of the axillary vein after ALND or sentinel node procedure. Clinical observation of BCRL-patients leads us to distinguish two groups: patients with deep pitting edema at the dorsum of the hand and forearm, and patients without. When a patient with a deep pitting edema is in orthostatic position with upper limb in adduction, hand skin looks rapidly hyperaemic, due to a vasodilation of the capillary bed. This vascular situation results from two phenomena: a less efficient venulo-arteriolar response, and the removal of the fatty tissue containing the lymph nodes during ALND together with opening of the axillary sheath. These architectural changes in the axilla lead to an impaired emptying of the axillary vein in upright position with upper limb pending. The orthostatic intermittent venous stenosis induces then collateralisation, by 3 main substitution pathways described in literature. In order to highlight these collateralisation pathways, we developed an original, simple, cheap and easy procedure, based on a deep infrared imaging (DIRI) device.
Material and Methods: The study is based on two groups of women. The control group consists of healthy women without breast pathology. The second group are all breast cancer patients, pre- and post-reconstruction, with and without BCRL. In all patients we performed visible light and DIRI of the complete thorax, including neck, shoulders and upper arms. Images were mixed and screened by 3 independent and blind operators. The operators screened for difference in temperature, existence and asymmetry of collateralisation , and anatomical areas of collateralisation .
Results: A total of 100 women were recruited, 50 in each group. The DIRI coupled with our reading grid seems to be specific and sensitive enough to identify BCRL patients with asymmetric collateralisation of the axillary vein.
Conclusion: DIRI and its reading grid seems to be a fast, cheap and useful tool in daily clinical practice to evaluate the hemodynamic changes of the axillary vein in breast cancer patients. This evaluation gives us more insight in the (future) development and eventual treatment of BCRL.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015