|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 608
Reply to 'comprehensive decongestive therapy in post-mastectomy lymphedema: An Indian perspective'
H Sreekar, AK Gupta, S Lamba, MK Sharma
Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Web Publication||1-Feb-2016|
Dr. H Sreekar
Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sreekar H, Gupta A K, Lamba S, Sharma M K. Reply to 'comprehensive decongestive therapy in post-mastectomy lymphedema: An Indian perspective'. Indian J Cancer 2014;51:608
|How to cite this URL:|
Sreekar H, Gupta A K, Lamba S, Sharma M K. Reply to 'comprehensive decongestive therapy in post-mastectomy lymphedema: An Indian perspective'. Indian J Cancer [serial online] 2014 [cited 2019 Dec 9];51:608. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/608/175381
We read with great interest the article titled, 'Comprehensive decongestive therapy in post-mastectomy lymphedema: An Indian perspective' in volume 48, issue 4. The authors have managed commendable results in the management of post-mastectomy lymphedema. The article also attempts to demonstrate the difference in volume reduction as measured with different methods like water volumetry and truncated cone formula, which is a well-accepted comparison.  Part of the reason in the difference in volume reduction in various studies is the difference in formulae and measurement methods used.
Casley-Smith in her article examined the various formulae and their validity in terms of error in projecting the volume differences.  She concluded that while measuring the volume reduction in unilateral lymphedema, it is best to use the following formulae.
Formula 1. Difference in edema = Final volume (F)/Normal limb volume (N) - Initial volume (I)/Normal limb volume (N) = F/N - I/N.
Formula 2. Change in edema = Difference in edema (F-I)/Initial edema (I-N) = (F-I)/(I-N). While the formula used in the article closely resembles formula 2, there may arise some errors while using it for demonstrating limb volume reduction.
In the study, the authors have used only 4 segments for the truncated cone formula i.e., they have used only 4 circumference measurements. Though this may be fairly accurate, it may not represent the true extent of arm edema. Generally accepted segmental length for volume measurement range from 2 cms to 10 cms. Latchford and Casley-Smith in their study concluded that the 10-cm and 1.5-in height intervals gave comparable results, and they stated that the 10-cm intervals were sufficient for routine measurements. 
Low stretch compression bandage is the prime component of decongestive lymphatic therapy. The bandage used by the authors Top Grip™ is a high stretch bandage as can be noted on the website and product monograph.  High stretch bandages have a high resting pressure and low working pressure and do not augment the lymphatic drainage during exercise. In contrast, the low stretch bandages have a low resting pressure and high working pressure. The lymphatics are compressed between the muscle and the bandage, causing them to pump. The lymphatics will pump only when they are compressed (by muscular contraction, massage, or other form of pressure) against something solid and unyielding. High stretch bandages give way and do not compress the lymphatics, which then do not pump. A bandage with low elasticity (low-stretch) causes a high pressure within the limb when a muscle contracts (the working pressure), thus compressing the lymphatics. The resting pressure, however, is low thus; the lymphatics can fill more readily. Exercise is important for the effect of short-stretch bandages to be optimized.  In our institute, we use Rosidal™ or Comprilan™, which are short stretch bandages. Though these are currently not freely available in India, they can be procured from abroad. Again, we would like to highlight the commendable work done by the authors in the often-neglected field of lymphedema.
| » References|| |
Stranden E. A comparison between surface measurements and water displacement volumetry for the quantification of leg edema. J Oslo City Hosp 1981;31:153-5.
Casley-Smith JR. Measuring and representing peripheral edema and its alterations. Lymphology 1994;27:56-70.
Latchford S, Casley-Smith JR. Estimating limb volumes and alterations in peripheral edema from circumferences measured at different intervals. Lymphology 1997;30:161-4.
Casley-Smith JR, Boris M, Weindorf S, Lasinski B. Treatment for Lymphedema of the Arm-The Casley- Smith Method. Cancer 1998;83 (12 Suppl American):2843-60.