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BRIEF REPORT
Year : 2009  |  Volume : 46  |  Issue : 4  |  Page : 337-339
 

Mechanical lymphatic drainage in the treatment of arm lymphedema


1 Department, Medicine School in Sao Jose de Rio Preto-FAMERP, Brazil
2 Occupational Therapist, Brazil
3 Department of the Medicine School in Sao Jose do Rio Preto-FAMERP, Brazil

Date of Web Publication9-Sep-2009

Correspondence Address:
Jose Maria Pereira de Godoy
Department of the Medicine School in Sao Jose do Rio Preto-FAMERP
Brazil
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DOI: 10.4103/0019-509X.55556

PMID: 19749466

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 » Abstract 

Exercising is one of the three cornerstones in the treatment of lymphedema together with contention mechanisms and lymphatic drainage. The aim of the current study was to evaluate a new method of mechanic lymphatic drainage. Volumetric reductions were evaluated after passive exercises in 25 patients with arm lymphedema resulting from breast cancer treatment. Their ages ranged between 42 and 86 years old. All patients were submitted to one-hour sessions using the RAGodoy® electromechanical apparatus which performs from 15 to 25 elbow bending and stretching exercises per minute. Volumetry, using the water displacement technique, was performed before and after the sessions. The paired t-test was employed for statistical analysis with an alpha error of less than 5% being considered acceptable. The reduction in volume was significant (P-value < 0.001) with a mean initial volume of 2026.4 and final volume of 1967.2 giving a mean loss of 59.2 mL. The RAGodoy® apparatus was efficient to reduce the volume of lymphedematous arms and is an option for the treatment of lymphedema.


Keywords: Apparatus, lymphatic drainage, lymphedema, treatment


How to cite this article:
Bordin NA, Guerreiro Godoy M, Pereira de Godoy JM. Mechanical lymphatic drainage in the treatment of arm lymphedema. Indian J Cancer 2009;46:337-9

How to cite this URL:
Bordin NA, Guerreiro Godoy M, Pereira de Godoy JM. Mechanical lymphatic drainage in the treatment of arm lymphedema. Indian J Cancer [serial online] 2009 [cited 2014 Sep 23];46:337-9. Available from: http://www.indianjcancer.com/text.asp?2009/46/4/337/55556



 » Introduction Top


Lymphedema is characterized by an abnormal accumulation of fluids and other substances in the tissue caused by a failure of the lymphatic drainage system associated to an insufficiency of extralymphatic proteolysis of the cellular interstice and mobilization of macromolecules. [1],[2] There is no specific therapy for lymphedema however an association of therapies, [3] including lymphatic drainage, [4],[5],[6] myolymphokinetic exercises, [7],[8] stockings and bandages, [9],[10],[11],[12] personal hygiene and care while performing day-to-day activities, [13],[14] psychological support, [15],[16] and drugs with a lymphokinetic action [17] is recommended. Exercising is one of the three cornerstones in the treatment of lymphedema together with contention mechanisms and lymphatic drainage. However, there are few studies evaluating mechanical lymphatic drainage of the arms. [18],[19]

The aim of the current study was to evaluate a new method of mechanical lymphatic drainage utilizing the RAGodoy® apparatus.


 » Method Top


Volumetric reductions were evaluated after passive exercises in 25 patients with arm lymphedema resulting from breast cancer treatment. Their ages ranged between 42 and 86 years old. The diagnosis of lymphedema was clinical confirmed by lymphoscintigraphy and volumetry. Lymphedema of the limbs was considered when the difference in volume was more than 200 mL when compared with the contralateral arm. Exclusion criteria were active infections and joint or neurologic limitations. Patients from the Lymphedema Treatment Center were selected according to the order of arrival and acceptance to participate in the study. All patients were submitted to a one-hour session using the RAGodoy® electromechanical apparatus which performs from 15 to 25 elbow bending and stretching exercises per minute. Volumetry was performed using the water displacement technique before and after the one-hour session. The paired t-test was utilized for statistical analysis with an alpha error of less than 5% being considered acceptable.

The study was approved by the Research Ethics Committee of the Institute of Biosciences, Languages and Exact Sciences (IBILCE) in São José do Rio Preto, Brazil.


 » Results Top


The reduction in the volume was significant ( P -value < 0.001) with a mean initial volume of 2026.4 and a final volume of 1967.2 giving an average loss of 59.2 mL. Of the 25 evaluations there was a reduction in 23 assessments and in only two there was an increase in volume. [Table 1] shows the volumetric measurements before and after each session.


 » Discussion Top


The current study demonstrates a new option of mechanical lymphatic drainage performed using a new apparatus specifically developed for the treatment of arm lymphedema. This apparatus was developed taking into account the venous and lymphatic return physiologies that utilize contraction mechanisms within the muscles to produce lymphovenous drainage. No apparatus has been reported in the literature with this characteristic of lymphatic drainage for the arms. The authors developed an apparatus with similar characteristics for the legs. [19],[20],[21]

An association of therapies is suggested for the treatment of lymphedema with this new approach being another option for arm lymphedema.

The precautions related to the use of the apparatus are the velocity and the time that each patient will tolerate exercising. Exercising can be performed continuously or at intervals depending on the patient. An increase of volume occurred in two patients during the exercising, however these patients were reevaluated after other one-hour sessions of exercises and they experienced a reduction in the volume of the arm. Hence, appropriate guidance is important for patients as they should not try to control the movements; they must be performed passively by the apparatus. It is important that the contraction mechanism drains more than the capacity of capillary filtration. Thus, passive exercises are better in the treatment of lymphedema because they demand a lower blood supply to the muscles and hence less capillary filtration.

 
 » References Top

1.Godoy JMP. Fisiopatologia do Sistema Linfático. In: Godoy JMP, Belczak CEQ, Godoy MFG. Reabilitação Linfovenosa. Rio de Janeiro; DiLivros: 2005. p. 37-41.  Back to cited text no. 1    
2.Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban and Fischer: 2003. p. 233.  Back to cited text no. 2    
3.Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban and Fischer: 2003. p. 280.  Back to cited text no. 3    
4.Godoy JMP, Godoy MFG. Manual lymph drainage: a new concept. J Vasc Br March 2004;03:77-80.  Back to cited text no. 4    
5.Godoy JMP, Braile DM, Godoy MFG. A Thirty-month Follow-up of the Use of a New Technique for Lymph Drainage in Six Patients. European Journal Vascular Endovascular Surgery 2002;3:91-3.  Back to cited text no. 5    
6.Wittlinger H, Wittlinger G. Textbook of Dr. Vodder's Manual Lymphatic Drainage. Brussels; HAUG: 1995. p. 124.  Back to cited text no. 6    
7.Pancheri MA. Tratamiento Miolinfokinético. In: Ciucci JL Linfedema Del Miembro Superior. Postratamiento Del Cáncer De Mama. Buenos Aires: Nayarit; 2004. p.110-22.  Back to cited text no. 7    
8.McKenzie DC, Kalda AL. Effect of Upper Extremity Exercise on Secondary Lymphedema in Breast Câncer Patients: A Pilot Study. Journal of Clinical Oncology 2003;21:463-6.  Back to cited text no. 8    
9.Artíbale MES, Godoy JMP, Godoy MFG, Braile DM. A new option for compression in the treatment of lymphedema in children. J Vasc Br 2005;4:311-3.   Back to cited text no. 9    
10.Foldi M, Foldi E, Kubik S.Compression Therapy. In: Textbook of Lymphology. For Physicians and Lymphedema Therapists. Munchen: Urban and Fischer; 2003. p. 528-88.  Back to cited text no. 10    
11.Thomas O' Donnell. Principles of Medical and Physical Treatment. In: Browse SN, Burnand KG, Mortimer OS Disease of the Lymphatics. London; Arnold: 2003. p.168.  Back to cited text no. 11    
12.GodoyJMP, Godoy MFG. Assessment of inelastic sleeves in patients with upper limb lymphoedema. Indian Journal of Physiotherapy and Occupational Therapy 2007;1:3-5.  Back to cited text no. 12    
13.Godoy JMP, Silva SH. Prevalence of cellulitis and erysipelas in post-mastectomy patients after breast câncer. Arch Med Sci 2007;3:249-51.  Back to cited text no. 13    
14.Godoy MFG. Atividades de Vida Diária no Tratamento do Linfedema. Lymphology 2002/03;35:213-5l.  Back to cited text no. 14    
15.Wilson RW, Hutson LM, Vanstry D. Comparison of 2 quality-of-life questionnaires in women treated for breast cancer: The RAND 36-Item Health Survey and the Functional Living Index-Cancer. Phys Ther 2005;85:851-60.  Back to cited text no. 15    
16.Critelli M, Lamuedra I. Tratamiento Psicológico. In: Ciucci JL Linfedema Del Miembro Superior. Postratamiento Del Cáncer De Mama. Buenos Aires:Nayarit, 2004. p. 143-50.  Back to cited text no. 16    
17.Ciucci JL, Ayguavella J. Tratamiento Farmacológico. In Ciucci JL Linfedema del Miembro Superior. Buenos aires; Nayarit: 2004. p.123-30.  Back to cited text no. 17    
18.Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema. BMC Cancer 2006;6:84.  Back to cited text no. 18    
19.Godoy JMP, Godoy MFG. Desarrollo y evaluación de un aparato para el drenaje de edemas. Angiología 2006;58:505-7.  Back to cited text no. 19    
20.Godoy JMP, Godoy MFG. New apparatus for mechanical lymph drainage in association of therapies in threatment od lymphoedema. Acta Phlebol 2005;6:125-8.  Back to cited text no. 20    
21.de Godoy JM, Godoy Mde F. Development and evaluation of a new apparatus for lymph drainage: preliminary results. Lymphology 2004;37:62-4.  Back to cited text no. 21    



 
 
    Tables

  [Table 1]

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