Indian Journal of Vascular and Endovascular Surgery (Jan 2019)
Comparing the efficacy of a combination of artificial lymphatics in the form of silicone tube and compressive therapy versus compressive therapy only in upper limb lymphedema following axillary lymph node dissection in breast cancer patients: A randomized controlled trial
Abstract
Objectives of this Trial: The objectives of this trial were to compare the treatment of lymphedema by creating artificial pathways along with standard compressive therapy versus standard therapy alone in Stage 2 and 3 lymphedema. Materials and Methods: A total of 18 patients were randomized into two groups. Silicone group (n = 8) received the placement of fenestrated silicone tubes subcutaneously from the hand to scapular region along with standard compression therapy, and the control group (n = 10) received standard compression therapy only. Follow-up was for 6 months. Results: A mean reduction of limb volume in the silicone group was 887 ml (25%), whereas in the control group, it was 250 ml (8%) (P = 0.01). All patients, 8 (100%) of silicone group and only 4 (40%) of control group, had ≥10% limb volume reduction at the end of 24 weeks with P = 0.013. More number of patients in the silicone group had a mean reduction in limb circumference of ≥2 cm as compared to the control group at almost all points of measurements along the limb with P < 0.05. There was a significant improvement in the quality of life, especially the functional domain in the silicone group with a P = 0.01. Improvement in pain-free range of motion in all major joints was observed in both the groups. No serious complications were reported. Postoperative ultrasonography and lymphoscintigraphy have shown patency of tubes, lymphatic fluid flow in silicone tubes. Postoperative indocyanine green lymphography showed decreased dermal backflow compared to preoperative. Conclusion: Combination of artificial lymphatics in the form of silicone tubes and standard care leads to a more significant reduction in the limb volume and limb circumference with improved quality of life with no serious complications.
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