Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes
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Abstract
Short stretch bandages are very effective in the initial management of arm lymphedema.
However, no studies to date have measured the pressure required to achieve specific
amounts of volume reduction. The purpose of this study was to determine whether there
is a difference between low and high-pressure bandaging in terms of therapeutically
intended volume reduction of the compressed arm.
Experimental, randomized and comparative study with two study-groups consisting of
high and low initial interface pressure bandages. Thirty-six hospitalized patients
in Nij Smellinghe hospital suffering from moderate to severe unilateral breast cancer-related
lymphedema not responsive to outpatient treatment were included. Bilateral arm volume
was measured by inverse water volumetry before, after two hours and after 24 hours
of bandaging. The amount of edema was calculated by subtracting the volume of the
diseased arm from that of the contralateral side. Sub-bandage pressure was measured
after bandage application and two hours later. Bandages were then re-applied and the
pressure was measured again. Twenty-four hours later, the pressure measurement was
repeated and bandages were removed for final volumetry. Patients were randomized into
two groups: group A received low pressure bandages (20-30 mm Hg) and group B received
high pressure bandages (44-58 mm Hg). The main outcome measures were reduction of
arm volume and edema volume in the affected arm in both study groups. Secondary outcome
parameters were changes in sub-bandage pressure and patient comfort.
Median arm volume reduction after two and 24 hours was 104.5 mL (95% confidence interval
[CI], 51.2-184.2) (-2.5%) (P < .0001) and 217 mL (95% CI, 143.9-280.2) (-5.2%) (P
< .01) for group A and 56.5 mL (95% CI, -2.7-123.1) (n.s.) and 167.5 mL (95% CI, 105.2-316.1)
(-4.2%) (P < .01) for group B, respectively. There was no statistically significant
difference between the volume changes in group A and group B. After 24 hours, edema
decreased by median percentage of 9.2% in group A and 4.8% in group B (n.s.). Bandages
in group A were better tolerated. The sub-bandage pressure drop in the first two hours
was between 41% and 48% in both treatment groups at both measuring sites. After 24
hours, the pressure drop was between 55% and 63%. No proximal swelling above the bandage
was observed.
Inelastic, multi-layer, multi-component compression bandages with lower pressure (20-30
mm Hg) are better tolerated and achieve the same amount of arm volume reduction as
bandages applied with higher pressure (44-58 mm Hg) in the first 24 hours.