Background
Symptomatic lymphedema patients are traditionally managed with physical therapy, but microsurgical methods are used in an increased manner for treating such cases. The purpose of this prospective control study is to evaluate in a long term period of up to six years the effectiveness of free LNT in stage-II lymphedema patients.
Methods
From January 2011 till June 2014 forty-one stage-II upper limb breast cancer related lymphedema patients were included in a prospective study. Clinical examination, MRI and lymphoscintigraphy of the affected limb were performed in all cases. For the initial design of the study, patients were randomly divided in two groups: Group-A patients (n=21, mean age 47 years) underwent microsurgical LNT; Group B patients (n=20, mean age 49 years) were managed by conservative therapy, including manual lymph drainage and compression garments, for six months. Post-operatively, Group A patients followed a similar six-month physiotherapy program. All forty-one patients stopped physiotherapy and compression bandaging at the sixth month and underwent re-examination of the affected extremities at the twelfth month; limb volume was measured, infection episodes were recorded, and subjective information regarding pain, feeling of heaviness and overall functional recovery, was also given by each patient. Patients of Group A continued to follow up yearly and their results are documented.
Results
At the end of the initial study, reduction of the limb volume was observed in both groups; mean reduction was greater in Group-A (57%) than in Group-B (18%). In Group-A, a mean 0,8 infection episodes per patient was documented, while three episodes per patient were recorded in Group-B. All Group-A patients reported painless and feeling of heaviness-free extremities with overall functional improvement. In Group-B, five out of twenty patients were painless, thirteen reported reduction of pain, while nine reported reduction of heaviness; only twelve patients stated subjective functional improvement of the limb, while eight reported no functional changes.
At the long term follow up with a mean period of 3 years and 11 months (range 30-72 moths), Group A patients recorded a mean volume reduction of 54,4%, mean infection episodes 0,2 per patient per year, and the subjective overall satisfaction remained as high as 100% for all the patients.
Conclusions
LNT represents an effective therapeutic approach for stage-II lymphedema patients; it significantly reduces the limb volume, decreases recurrent infections and improves the overall function of the affected extremity. Future studies are designed for further improvement of the volume reduction, as well as minimization of the infection episodes with the use of new technologies of purified collagen matrix. Our aim is to use the BioBridgeTM purified collagen matrix as a support in accelerating the lymphagiogenesis between the transplanted at the axilla lymph nodes and the upper limb lymphatic vessels.