New Lymphedema Treatment Clinic - Myrtle beach, Souther Carolina

It gives me great pleasure to announce a new lymphedema treatment clinic in the Myrtle Beach, Souther Carolina area:

Tom Kincheloe, OTR/L, CLT
Founder/Clinical Director
RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC.
100 Prather Park Drive, Suite A
Myrtle Beach, SC 29588-7910
Bus. Phone: (843) 742-5701
Bus. Fax: (843) 742-5704
Cell: (843) 957-2422
Email: erivertownlymph@sc.rr.com

I know Tom personally and two things strike me about him.

First, is his real concern/compassion for his patients.

Secondly is his knowledge of lymphedema.

A winning combination! So if you live in his area and are looking for lymphedema help, give him a call.

Pat

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

One of my desires is to bring all types of information relating to leg lymphedema to the readers. I must admit,

I really had to grit my teeth on this article.

The authors speak of a long term follow up time frame as 31 months. This is hardly adequate when you are

investigating long term possible complications. Indeed, I had the Thompson'sprocedure done in three surgeries

from 1971 through 1973. The first 31 months did see a reduction in leg size and a slight reduction in cellulitis

episodes.

However, long term should mean a 10, 20 or even longer time frame. After twenty years, I experienced horrific

complications from the surgery, not the least of all was mixed b-cell lymphoma.

Also, if the research proves to be correct about the possibilities that secondary lymphedema patients

are people who are already "at risk" for lymphedema, then the introduction of yet another area of surgery (abdomen)

could prove to be disasterous as well. Any type of surgery that would injury, damage or adversly effect the lymph

system in the abdomen can (as has been well documented) cause abdominal lymphedema.

Please do not consider the posting of this article as an endorsement of any kind and I would further discourage

lymphedema patients from having it.

Pat

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

Ann Plast Surg. 2009 Jan

Parrett BM, Sepic J., Pribaz JJ

Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115

Lymphedema is common after inguinal lymphadenectomy or resection of groin tumors. Animal studies have shown success using the rectus abdominis musculocutaneous (RAM) flap as a treatment for lymphedema. Four patients with acquired lower extremity lymphedema were treated with a contralateral RAM flap with an inferior cutaneous pedicle left intact to facilitate lymphatic drainage into the unaffected groin. One patient also had lymphaticovenous anastomoses performed during flap transfer. All flaps survived with no postoperative complications. With a mean follow-up of 31 months, the mean reduction in limb circumference from the preoperative excess was 81% at the thigh, 70% at the calf, and 71% at the ankle. None of the patients with recurrent cellulitis had further incidences of groin cellulitis. Two patients required future flap debulking. Lymphoscintigraphy was performed in 1 patient and demonstrated reconstitution of lymphatic flow from the affected leg through the flap. According to this preliminary study, transfer of a contralateral RAM flap to the groin of a lymphedematous leg improves lymphedema and decreases the incidence of cellulitis.

PubMed

For further information on surgeries used for the treatment of lymphedema, please see:

Surgery for Lymphedema

and

The Thompson's Procedure

Lighthouse Lymphedema Network

I wanted to make a special announcement that the Lighthouse Lymphedema Network
is now on Facebook.

You can join by going to: Lighthouse Facebook

There is also an area where you can post and participate.

AND - don't forget our upcoming program in October. We will be having both a
parenting network and a teen network this year....be there or be square!

see the details for that at:

Lighthouse Lymphedema Network

**yes, I'm on it too :-)

Pat

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

BMC Cancer. 2009 Feb

Tada H, Teramukai S, Fukushima M, Sasaki H.

Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital,

Corresponding author.

Harue Tada: haru.ta@kuhp.kyoto-u.ac.jp; Satoshi Teramukai: steramu@kuhp.kyoto-u.ac.jp; Masanori Fukushima:mfukushi@kuhp.kyoto-u.ac.jp; Hiroshi Sasaki: hrssasaki@jikei.ac.jp

BACKGROUND: Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma.

METHODS: A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with endometrial cancer) who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema.

RESULTS: Among ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20-2.67; p = 0.006) was statistically significantly associated with occurrence of lymphedema.

CONCLUSION: There was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.

PubMedCentral

*Editor's note: It is rare that I openly place a note of disagreement on an article, but in this case, I think one is called for. The incident ratio of lower limb lymphedema from gynecological cancer is skyrocketing with survival rates increasing as well. It is well document that the removal of lymph nodes damages the lymph system and that a damaged lymph system can lead to lymphedema. I would suggest that they doctors involved in this study go back to their research. Pat

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Clin Nucl Med. 2009 Jul

Bourgeois P, Dargent JL, Larsimont D, Munck D, Sales F, Boels M, De Valck C.

Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. pierre.bourgeois@bordet.be

PURPOSE: Angiomyomatous hamartoma (AH) of the lymph node is a rare vascular benign disease of unknown etiology with a predisposition for the lymph nodes of the inguinal area. Only 18 cases have been described up to now in the literature and the disorder was reported to be associated with lymphedema or swelling of the ipsilateral limb in 4 patients. However, scintigraphic investigation of the lymphatic system in these patients was reported in only 2 cases.

MATERIAL AND METHODS: Five patients where the biopsy of inguinal nodes for suspected lymphadenitis led to the diagnosis of angiomyomatous hamartoma were investigated using lymphoscintigraphic techniques (1 girl aged 15; 1 boy aged 9 at the time of first biopsy and 11 at the time of the second one; and 3 men aged 30, 50, and 57). The operated limb was lymphedematous in 3 and 1 developed lymphedema after biopsy. The fifth patient developed a contralateral lymphedema after his second nodal biopsy.

RESULTS: In all cases, lymphoscintigraphic investigation of the limbs showed extensive lymph node abnormalities on the operated side and in 4 cases on the opposite side.

CONCLUSIONS: These observations support not only the hypothesis that lymphatic disturbance was involved in the pathogenesis of these tumors but also the proposition that lymphoscintigraphy should be performed in cases of inguinal lymphadenitis of unknown origin to diagnose the underlying situation of latent lymphedema.

Clinical Nuclear Medicine

Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications

Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications

Ann Plast Surg. 2009 Aug

Chen HC, Gharb BB, Salgado CJ, Rampazzo A, Xu E, di Spilimbergo SS, Su S.

Department of Plastic Surgery, E-Da Hospital/I-Shou University, Taiwan.

Entry lesions at the toes interdigital spaces, in the setting of chronic lymphedema, are strongly associated with repetitive infective episodes which cause significant morbidity. A prospective study was designed to evaluate the outcome in 2 groups of patients affected by end stage III lymphedema of the lower extremity, treated with the Charles procedure with or without simultaneous amputation of the toes. At a mean 3 years of follow-up, 20% of the patients receiving elective toes amputation experienced recurrence of the infection and none required more proximal amputations. Among the patients not desiring elective toes amputation; 83% suffered multiples attacks of cellulitis and in 88% the toes were eventually amputated. The difference in the number of infective episodes between the 2 groups was highly significant. No cases of recurrent lymphedema were registered. Elective toes amputation in combination with the Charles procedure reduces recurrent cellulitis and long-term morbidity in stage III lymphedema of the lower leg.

Lippincott, Williams & Wilkins

The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg

The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg
Fukuoka Igaku Zasshi. 2009 Jun

Nakao F, Furutani A, Yoshimura K, Hamano K, Kinoshita Y, Kawamoto R, Nakao H, Suzuki S.
Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

Lymphedema is a chronic problem causing distress and loss of functions throughout the lifespan. Complex decongestive physiotherapy (CDP) is in common use in developed countries but has only recently been used in Japan for people in outpatient settings. CDP is a representative conservative treatment for lymphedema, conducted by combining four kinds of physical therapies: skin care, manual lymph drainage (MLD), bandage and exercise. This research project lead by a nurse is underway using CDP in an outpatient department. We report a case of secondary lymphedema caused by infection successfully treated by CDP. A 22-year-old man suffered from cellulitis of unknown origin when he was a high school student. After this event, he had been repeatedly admitted to hospital with infections as a result of the lymphedema. He underwent MLD once or twice monthly and received health education for skin care, self-massage and exercise, and was advised to wear compression stockings. Within 7 months the leg swelling had significantly reduced and his feelings of malaise and pain disappeared. Fourteen months later the circumferences of his knee and ankle had kept the sizes, and he has not re-entered hospital for infections. For this man, CDP had a positive outcome, as it has for many others around the world. Our experience has found it very important to establish adequate support systems for such people in outpatient and community settings. However, more research and knowledge sharing are required to understand the usefulness and effectiveness about this program as a primary treatment combined with health education in community settings in Japan.

PubMed