Comparison of circumference of women’s upper limbs after radical breast amputation subjected and not subjected to early professional rehabilitation

Elżbieta Niedbała, Leszek Kołodziejski

E. Niedbała, L. Kołodziejski – Porównanie obwodów kończyn górnych u kobiet po radykalnym leczeniu raka piersi korzystających i nie korzystających z wczesnej profesjonalnej rehabilitacji. FP 2013; 13(4); 37-43

Abstract

Removing the lymphatic system of the armpit during the radical mastectomy hinders the outflow of lymph from the upper limb. Aim of the work. The aim of this report is to compare the circumference of women’s upper limbs post-surgical breast cancer undergone to early professional and unprofessional rehabilitation. Material and methods. A group of 146 members of Amazon Club subjected to radical breast amputation by Maddens methods between 2002-2009, have been evaluated. 71 patients from Malopolska (M group) were operated on in the Oncological Centre of Krakow (OCK) and 75 from Świętokrzyskie (Ś group) were operated on in the Świętokrzyskie Oncological Centre in Kielce (SCO). For all the patients the same, standard oncological procedures were used. The only significant difference between the medical centres was the method of conducting early post operative rehabilitation. In the M group it was conducted by trained nurses and volunteers of Amazon Club and the patients continued their exercises on their own at home. In Ś group a complex rehabilitation in the stationary conditions was conducted by professional physiotherapists. Data of all the women have been obtained including the patients’ age, past treatment and rehabilitation or the circumference of upper limbs were done. Women from both groups (M i S) were compared regarding antropometric features, past treatment and circumference of upper limbs and development of lymphedema. Results. In spite of the considerable difference in the method of early postoperative rehabilitation the patients from M i S did not differ significantly as regards circumference of their upper limbs, occurrence and volume lymphedema on the operated side.
Conclusions:
1. At women after radical mastectomy subjected to the early professional and unprofessional rehabilitation, in the late period of observation, the circumference of their upper limbs were the similar.
2. In both groups M i S the percentage of women with lymphedema was low.

Key words:
mastectomy, circumference upper limbs, lymphedema

Possible applications of dynamic taping in women after the removal of lymph nodes because of breast cancer

Anna Lipińska, Magdalena Lipińska-Stańczak, Paweł Macek, Renata Szczepaniak, Sławomir Jandziś, Zbigniew Śliwiński

A. Lipińska, M. Lipińska-Stańczak, P. Macek, R. Szczepaniak, S. Jandziś, Z. Śliwiński: Possible applications of dynamic taping in women after the removal of lymph nodes because of breast cancer. FP 2015;15(4);16-31

Abstract
Introduction. In Poland and in the world breast cancer is the most frequent malignancy among women. Complications occurring after the applied therapy lower the quality of patients’ life. One of the many adverse effects of breast cancer treatment is lymphedema. Removal of lymph nodes and damage to lymphatic vessels make the transport of high-molecular proteins difficult, and at the same time, they have an influence on an increase in the colloid-osmotic pressure, water retention in the inter-tissue space, the loss of lymphatic vascular tone and reduction of the hydrostatic pressure. If not treated, lymphedema causes ailments in the form of recurrent inflammatory conditions of the skin, lymphatic vessels, which greatly reduces the patients’ psychophysical efficiency and promotes the development of lymphosarcoma of the upper limb on the side of mastectomy. One of the methods of lymphedema treatment is Kinesiology Taping. In Poland, the term dynamic taping is more and more frequently used. Application of this method causes that healing processes occur in the patient in a painless and natural way.
Aim. To present the possibilities of using lymphatic techniques of dynamic taping in women after mastectomy and to assess the impact of the applications on the secondary lymphedema.  The author decided to verify the main objective through the following research hypotheses:
1.Applications of dynamic taping reduce lymphedema in women after mastectomy.
2.Techniques of the Kinesiology Taping method influence the change of motion ranges in the joints of the upper limb.
Material and research methods. The study was performed in the Department of Rehabilitation of Holycross Cancer Centre in Kielce. The study group consisted of 73 patients after mastectomy diagnosed with secondary lymphedema of the upper limb. The volume of upper limbs was measured with the use of a measuring cylinder filled with water. Measurements of motion ranges in the joints of upper limbs were performed with the use of a goniometer.
Results and conclusions. Analysis of the results shows that the employed lymphatic applications reduce lymphedema, increase the range of motion in the joints of the upper limb on the operated side and promote healing processes, contributing to the improvement of physical efficiency and the quality of life.

Key words:
breast cancer, lymphedema, dynamic taping, Kinesiology Taping

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Opóźniona diagnoza i leczenie pierwotnego obrzęku limfatycznego kończyn dolnych – studium przypadku / Delayed diagnosis and treatment of primary lymphoedema of lower limbs – case study

Rita Hansdorfer-Korzon, Jacek Teodorczyk, Marcin Gruszecki, Michał Korzon

FP 2016;16(2);42-53

Streszczenie
Leczenie pierwotnego obrzęku limfatycznego stwarza wiele problemów pacjentowi jak i całemu zespołowi medycznemu. Całkowite wyleczenie bowiem z racji uszkodzenia anatomicznych dróg odpływu chłonki nie jest możliwe, a terapia ma na celu jedynie zmniejszenie rozmiarów kończyny, przywrócenie jej funkcji i poprawienie aspektów kosmetycznych. Leczenie jest trudne, wieloetapowe i nawet w przypadku dobrych wyników kosztowne i czasochłonne. Obrzęki pierwotne nie są patologią bardzo częstą, toteż problem związany z ich diagnostyką i leczeniem pozostaje często na marginesie zainteresowania lekarzy. W przeciwieństwie do dobrze zorganizowanej pomocy, jaką otrzymują chorzy z obrzękiem w obrębie kończyn górnych (głównie po leczeniu chirurgicznym raka sutka) możliwości rozpoznania, diagnostyki i wdrożenia postępowania usprawniającego u osób z idiopatyczną postacią obrzęku limfatycznego kończyn dolnych są istotnie ograniczone. Chociaż w ostatnich latach intensywnie propagowana jest wiedza dotycząca zasad stosowania terapii przeciwzastoinowej nadal w wielu ośrodkach wdrażana jest nieprawidłowo. Nieleczony lub niewłaściwie leczony obrzęk staje się nieodwracalny wskutek rozplemu tkanki łącznej, czym różni się od obrzęków na innym podłożu. Narastający obrzęk doprowadzający do stopniowej deformacji i zaburzeń funkcji kończyny, wpływa negatywnie na stan psychiczny pacjenta. Późne rozpoznanie, kosztowne, uciążliwe i długotrwałe leczenie, którego efekt jest niejednokrotnie niezadawalający wpływa istotnie na jakość życia chorego. W pracy przedstawiono jeden z licznych przypadków pacjentek z rozpoznanymi późno i nieprawidłowo leczonymi obrzękami pierwotnymi, które mają być ilustracją typowych zaniedbań w dążeniu do ustalenia diagnozy i wdrożenia leczenia w tej jednostce chorobowej. Podkreślono także rolę badania LS jako złotego standardu w diagnostyce obrzęków pierwotnych i jej ograniczonej przydatności w ocenie skuteczności leczenia.

Słowa kluczowe:
obrzęk limfatyczny, pierwotny wrodzony obrzęk limfatyczny, rehabilitacja, limfoscyntygrafia


Abstract
Treatment of lymphoedema is problematic for the patient and the entire medical team. Complete recovery, because of anatomical damage to the outflow tract of lymph, is not possible and the therapy is intended only to reduce the size of the limb, restore its function and improve the cosmetic aspects. Treatment is difficult, multistage, unpredictable and even if results are good, expensive and time consuming. Primary lymphoedema is not common disease, so the problem of its diagnosis and treatment is often on the margins of medical concern. In contrast to the well-organized support received by patients with secondary oedema of the upper, diagnosing and implementation of rehabilitation in patients with idiopathic lymphoedema of the lower limbs are significantly limited. Although in recent years is intensely propagated knowledge of the principles of anticongestive therapy, it is still is implemented incorrectly in many centers. If left untreated or improperly treated swelling becomes irreversible as a result of proliferation of connective tissue, what differs from cases of oedema not associated with lymphatics damage. Increasing swelling will lead to progressive deformity and dysfunction of limbs and negatively affects the mental state of the patient. Late diagnosis, costly, cumbersome and long-term treatment with the often unsatisfactory effect significantly affect quality of life. The paper presents one of many our cases of patients with late diagnosed and improperly treated primary lymphoedema and is an illustration of the typical negligence in establishing the diagnosis and initiation of treatment in this disease entity.

Key words:
lymphedema, primary congenital lymphedema, rehabilitation, lymphoscintigraphy

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Evaluation of Impact of the Application of Kinesio Taping and Standard Complete Decongestive Therapy on the Lymphedema in Women After Mastectomy

Jolanta Darowska-Olszewska, Zbigniew Śliwiński

J. Darowska-Olszewska, Z. Śliwiński – Evaluation of Impact of the Application of Kinesio Taping and Standard Complete Decongestive Therapy on the Lymphedema in Women After Mastectomy. FP 2016; 16 (3); 18-32

Abstract
Introduction. The objective of this study has been to evaluate treatment results in the upper extremity on the side after surgery, in women after the mastectomy procedure, with the application of the Standard Complete Decongestive Therapy and the Modified Complete Decongestive Therapy, where the multilayer bandaging has been replaced with the lymphatic applications of the Kinesio Taping method. The above objective has been verified by testing the following hypotheses:
1. Lymphatic applications of the Kinesio Taping method can replace the multilayer bandaging.
2. Kinesio Taping techniques affect the range of motion in the shoulder joint.
3. Kinesio Taping applications reduce pain in the upper extremity, on the side after surgery.
Materials and Methods. Total number of 24 women after the unilateral mastectomy have been examined. The test group encompassed 12 patients, to whom the lymphatic Kinesio Taping techniques have been applied. The control group constituted of 12 patients, who have been treated with the multilayer bandaging. Both groups, over the period of 15 days, have been subjected to a 30-minutes manual lymphatic drainage procedure and to 20 minutes of rehabilitation exercises. Before and after the therapy, the upper extremity circumference has been measured using a centimeter tape. The shoulder joint range of motion has been measured with a goniometer. The pain level has been assessed according to VAS scale.
Results. Analysis of the obtained results show, that the lymphatic tape applications used reduce lymphedema and pain sensation, and increase the range of motion in the shoulder joint on the side after surgery, in women after the mastectomy procedure.
Conclusions. The applied Kinesio Taping techniques, when compared with the multilayer bandaging of the Complete Decongestive Therapy, bring about the comparable results.

Key words:
lymphedema, Kinesio Taping, Complete Decongestive Therapy

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