Artículos Seleccionados 1998 - FLEBOLOGIA y DRENAJE LINFATICO.

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Comparison of sequential compression devices and foot pumps for prophylaxis of deep venous thrombosis in high-risk trauma patients.

Manual lymphatic drainage for chronic post-mastectomy lymphoedema treatment.

The role of pneumatic compression in the treatment of postmastectomy lymphedema. A randomized phase III study.

Postmastectomy lymphedema management: evolution of the complex decongestive therapy technique.

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Título en Inglés: Comparison of sequential compression devices and foot pumps for prophylaxis of deep venous thrombosis in high-risk trauma patients.

Autor/es: Spain-DA; Bergamini-TM; Hoffmann-JF; Carrillo-EH; Richardson-JD

Lugar: Department of Surgery, University of Louisville, Kentucky 40292, USA.

Fuente: Am-Surg. 1998 Jun; 64(6): 522-5; discussion 525-6

ISSN: 0003-1348

Idioma: ENGLISH

Resumen: Multiple-trauma patients are at increased risk for deep venous thrombosis (DVT) but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Sequential pneumatic compression devices (SCDs) are an alternative for DVT prophylaxis. However, lower extremity fracture or soft tissue injury may preclude their use. In these circumstances, foot pumps (FPs) are often substituted, yet little clinical data exist to support their use. We identified 184 consecutive high-risk trauma patients who received DVT prophylaxis with compression devices. We reviewed demographic data, mechanism of injury, Injury Severity Score, injury pattern, and method of prophylaxis. Generally, SCDs were preferred, but FPs were substituted in patients with lower extremity injuries. Occurrences of DVT or pulmonary embolism were also noted. Patients surviving less than 48 hours were excluded. SCDs were used in 118 patients (64%) and FPs in 66 patients (34%). There were no differences in age, Injury Severity Score, or presence of shock on admission. As expected, FP patients were more likely to have lower extremity fractures (65 vs 26%; P < 0.05) and were also more likely to have associated pelvic fracture (59 vs 25%; P < 0.05) and chest injury (61 vs 26%, P < 0.05). There was no difference in the incidence of head injury, although SCD patients had more severe head injuries (Glasgow Coma Score, 7.9 vs 10.5; P < 0.05). The overall incidence of DVT was 5.4 per cent (10 of 184), with no differences between the two groups (SCD 7% vs FP 3%). Three patients had a pulmonary embolism (FP, two; SCD, one), none of which were fatal. Compression devices provide adequate DVT prophylaxis with a low failure rate (3-8%) and no device-related complications. FPs appear to be a reasonable alternative in the high-risk trauma patient when lower extremity fractures precludes use of SCD.

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Título en Inglés: Manual lymphatic drainage for chronic post-mastectomy lymphoedema treatment.

Autor/es: Fiaschi-E; Francesconi-G; Fiumicelli-S; Nicolini-A; Camici-M

Lugar: Rehabilitation and Physical Therapy Unit S. Chiara Hospital, Pisa University, Italy.

Fuente: Panminerva-Med. 1998 Mar; 40(1): 48-50

ISSN: 0031-0808

Idioma: ENGLISH

Resumen: BACKGROUND: The authors evaluated the chronic post-mastectomy lymphoedematous tissue and the effects of manual lymphatic drainage (Leduc method) with and without compressive bandage. METHODS: The arms were measured before and after physical therapy and the results were expressed as a percentage decrease. Physical therapy was performed first by manual lymphatic drainage only and after by manual lymphatic drainage plus compressive bandage. RESULTS: We observed that during manual lymphatic drainage plus compressive bandage the total percentage decrease of whole limb was the highest: 41.1 +/- 12.2% versus 30.4 +/- 15.8% (p < 0.05). Clinical and physiopathological implication are discussed.

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Título en Inglés: The role of pneumatic compression in the treatment of postmastectomy lymphedema. A randomized phase III study.

Autor/es: Dini-D; Del-Mastro-L; Gozza-A; Lionetto-R; Garrone-O; Forno-G; Vidili-G; Bertelli-G; Venturini-M

Lugar: Divisione di Oncologia Medica I, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.

Fuente: Ann-Oncol. 1998 Feb; 9(2): 187-90

ISSN: 0923-7534

Idioma: ENGLISH

Resumen: BACKGROUND: Pneumatic compression is a frequently prescribed physical therapy for patients affected by postmastectomy lymphedema but, despite its wide use, its efficacy has not been demonstrated in phase III studies. We performed a randomized study comparing pneumatic compression versus no treatment in patients with postmastectomy lymphedema. PATIENTS AND METHODS: Patients with monolateral postmastectomy lymphedema were randomized to receive two cycles of intermittent pneumatic compression (PC group), i.e., five two-hour sessions per week for two weeks, to be repeated after a five-week interval, or to no treatment (control group). The patients in both groups were instructed as to the prophylactic hygienic care of the limb. Lymphedema was assessed by the sum of differences in circumference measurements between affected and normal limbs ('delta'). Response was defined as a > or = 25% reduction in delta value. RESULTS: Eighty patients entered the study. No statistically significant differences in response rates between the two groups were observed: 20% in the control group (95% CI: 9%-36%), 25% in the PC group (95% CI: 13%-41%, P = 0.59). The absolute mean decrease in delta value was 1.9 +/- 3.7 cm in the PC group and 0.5 +/- 3.3 cm in the control group. CONCLUSIONS: We demonstrated that intermittent pneumatic compression has a limited clinical role in the treatment of postmastectomy lymphedema. Efforts to prevent this complication should be undertaken.

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Título en Inglés: Postmastectomy lymphedema management: evolution of the complex decongestive therapy technique.

Autor/es: Daane-S; Poltoratszy-P; Rockwell-WB

Lugar: Division of Plastic Surgery, University of Utah Health Sciences Center, Salt Lake City 84132, USA.

Fuente: Ann-Plast-Surg. 1998 Feb; 40(2): 128-34

ISSN: 0148-7043

Idioma: ENGLISH

Resumen: Extremity lymphedema, historically a surgical disease, is now successfully managed with a physical therapy regimen called complex decongestive therapy, which originated in Europe. Herein we present a historical perspective on the understanding and treatment of lymphedema. We review a series of 20 patients with postmastectomy arm edema who were treated with complex decongestive therapy and were followed for 6 months. On average these patients achieved a stable 73% reduction in arm circumference.

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