CHAPTER 13 Pathophysiology of Secondary Lymphedema

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

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Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1713667 ◽

2020 ◽

Vol 36 (08) ◽

pp. 606-615

Author(s):

Halley Darrach ◽

Pooja S. Yesantharao ◽

Sarah Persing ◽

George Kokosis ◽

Hannah M. Carl ◽

...

Keyword(s):

Quality Of Life ◽

Upper Extremity ◽

Nonoperative Management ◽

Multivariable Analysis ◽

Sociodemographic Factors ◽

Surgical Patients ◽

Linear Modeling ◽

Secondary Lymphedema ◽

Nonsurgical Management

Abstract Background Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema. Methods This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann–Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL. Results Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p = 0.04), and mental (77.0 vs. 52.7, p = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis. Conclusion Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.

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Does Exercise Have a Preventive Effect on Secondary Lymphedema in Breast Cancer Patients Following Local Treatment - A Systematic Review

Breast Care ◽

10.1159/000487428 ◽

2018 ◽

Vol 13 (5) ◽

pp. 380-385 ◽

Cited By ~ 8

Author(s):

Freerk T. Baumann ◽

Alexandra Reike ◽

Michael Hallek ◽

Joachim Wiskemann ◽

Vanessa Reimer

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Strength Training ◽

Local Treatment ◽

Exercise Group ◽

Current Data ◽

Cochrane Library ◽

Breast Cancer Patients ◽

Preventive Effect ◽

Secondary Lymphedema

Background: Secondary lymphedema (SL) is a possible side effect of breast cancer treatment. Current data describe a positive influence of exercise on upper lymphedema. This systematic review evaluates studies examining a potential preventive effect of exercise on SL incidence. Methods: A systematic literature search of PubMed, LIVIVO, and the Cochrane Library was performed. Results: 8 randomized controlled trials were included in the review. 3 studies investigated the effect of strength training, and 5 the effect of combined exercise therapy. 5 studies included participants without lymphedema at study entry, and 3 studies included both patients with and without lymphedema. The partly significant results showed that progressive strength training as well as combined dynamic exercise therapies consisting of physiotherapy, physical therapy, and/or kinesiotherapy are safe and can prevent SL. Onset as well as diagnosis of lymphedema were significantly decreased in 5 studies in the exercise group. Conclusion: All 8 studies included indicate a potential preventive effect of exercise on SL; however, further research is needed.

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Use of non-contrast MR in diagnosing secondary lymphedema of the upper extremities

Clinical Imaging ◽

10.1016/j.clinimag.2021.08.018 ◽

2021 ◽

Author(s):

Geunwon Kim ◽

Kevin Donohoe ◽

Martin P. Smith ◽

Ryoko Hamaguchi ◽

Anna Rose Johnson ◽

...

Keyword(s):

Upper Extremities ◽

Secondary Lymphedema

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Investigating the Lymphatic System by Dual-Color Elemental Mass Spectrometry Imaging

Contrast Media & Molecular Imaging ◽

10.1155/2017/4035721 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8

Author(s):

Ann-Christin Niehoff ◽

Tim Klasen ◽

Rebecca Schmidt ◽

Daniel Palmes ◽

Cornelius Faber ◽

...

Keyword(s):

Mass Spectrometry ◽

Lymph Nodes ◽

Contrast Agents ◽

Inductively Coupled Plasma ◽

Mass Spectrometry Imaging ◽

Lymphatic System ◽

Diagnostic Tools ◽

Lymphatic Flow ◽

Secondary Lymphedema ◽

Inductively Coupled

Secondary lymphedema accompanied with strong restrictions in quality of life is still major side effects in cancer therapy. Therefore, dedicated diagnostic tools and further investigation of the lymphatic system are crucial to improve lymphedema therapy. In this pilot study, a method for quantitative analysis of the lymphatic system in a rat model by laser ablation (LA) with inductively coupled plasma mass spectrometry imaging (ICP-MSI) is presented. As a possible lymph marker, thulium(III)(1R,4R,7R,10R)-α,α′,α′′,α′′′-tetramethyl-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate (Tm-DOTMA) is introduced and compared to the clinically used magnetic resonance imaging contrast agent gadolinium(III)2,2′,2′′-(10-((2R,3S)-1,3,4-trihydroxybutan-2-yl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl)triacetate (Gd-DO3A-butrol). Gadobutrol functioned as standard contrast media in MRI lymphangiography to detect lymphatic flow qualitatively. Thus, Tm-DOTMA was investigated as lymphatic marker to detect lymphatic flow quantitatively. Both contrast agents were successfully used to visualize the lymphatic flow in successive lymph nodes in LA-ICP-MS due to lower limits of detection compared to MRI. Furthermore, the distribution of contrast agents by multicolored imaging showed accumulation in specific areas (sectors) of the lymph nodes after application of contrast agents in different areas.

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