Management of Peripheral Edema, Including Lymphedema of the Arm after Radical Mastectomy

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INCAPACITATING, intractable edema of the extremities has long been a difficult problem to manage. Surgical attempts to create new lymphatic channels by means of subcutaneous tubes, strings, or pedicled skin grafts have not been consistently successful. In recent years, encouraging results have been achieved with technically improved methods of correcting, when possible, the underlying causes of vascular obstruction or insufficiency, reducing the weight of the obese patient, and selectively using diuretics and various forms of elastic or other compressive supports.

The purpose of this report is to describe a program of management that has been successful in 26 consecutive patients with edema of the arm, and in 83 consecutive patients with edema of the leg. Treatment is based upon the principle of squeezing edema fluid from the extremity by gentle, controlled pneumatic massage, then measuring and precisely fitting the extremity with a prestressed, elastic sheath.* The function of the sheath is to maintain interstitial pressure that favors continuous capillary absorption of the edema fluid. The special advantage of the elastic sleeves and stockings used in this study, over the commercial products in standard sizes, is in the precise individual fitting of the extremity.

Considerations in Treatment—The Upper Extremity

The incidence (up to 30 per cent) of edema of the arm following radical mastectomy attests to the fact that this is a common and serious complication. The extensive removal of axillary lymphatic channels and the stripping of the adventitia of the axillary vein leave only a few lymphatic channels1 to. . .



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