The effects of bandaging with an additional pad and taping on secondary arm lymphedema in a patient after mastectomy
Identifieur interne : 002317 ( Pmc/Corpus ); précédent : 002316; suivant : 002318The effects of bandaging with an additional pad and taping on secondary arm lymphedema in a patient after mastectomy
Auteurs : Junghwa Do ; Jaeyong Jeon ; Won KimSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2017.
Abstract
[Purpose] The purpose of this case study was to determine the effectiveness of bandaging the arm of a patient with secondary lymphedema on the patient’s quality of life, arm volume and arm function using an additional pad and taping along with some other standard therapy modalities for lymphedema. [Subjects and Methods] I used a bandage with an additional pad and taping, along with MLD, exercise, and skin care to treat a patient with unilateral breast-cancer-related arm lymphedema who had fibrotic tissue on her lower arm and hand. I made a pad called a “muff” and applied it under tape while using Vodder’s technique. Treatment was performed during 5 therapy sessions a week for 2 weeks. [Results] After the physiotherapy sessions, the excess edema volume decreased to 608 ml, and the percentage of excess volume (PEV) was 9.6%. The therapeutic efficacy, measured as percentage reduction of excess volume (PREV), was −79.5%, meaning that the edema volume was reduced 79.5%. The use of an additional pad and taping on a large edematous site with fibrotic changes can produce more efficacious lymphedema care. [Conclusion] The use of an additional pad and taping on a large edematous site with fibrotic changes has demonstrated a positive result in lymphedema management for a post mastectomy patient and, therefore, further studies on this method are suggested with a larger sample size.
Url:
DOI: 10.1589/jpts.29.1272
PubMed: 28744063
PubMed Central: 5509607
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The effects of bandaging with an additional pad and taping on secondary arm
lymphedema in a patient after mastectomy</title><author><name sortKey="Do, Junghwa" sort="Do, Junghwa" uniqKey="Do J" first="Junghwa" last="Do">Junghwa Do</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Jeon, Jaeyong" sort="Jeon, Jaeyong" uniqKey="Jeon J" first="Jaeyong" last="Jeon">Jaeyong Jeon</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Won" sort="Kim, Won" uniqKey="Kim W" first="Won" last="Kim">Won Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28744063</idno><idno type="pmc">5509607</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509607</idno><idno type="RBID">PMC:5509607</idno><idno type="doi">10.1589/jpts.29.1272</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002317</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002317</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The effects of bandaging with an additional pad and taping on secondary arm
lymphedema in a patient after mastectomy</title><author><name sortKey="Do, Junghwa" sort="Do, Junghwa" uniqKey="Do J" first="Junghwa" last="Do">Junghwa Do</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Jeon, Jaeyong" sort="Jeon, Jaeyong" uniqKey="Jeon J" first="Jaeyong" last="Jeon">Jaeyong Jeon</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Won" sort="Kim, Won" uniqKey="Kim W" first="Won" last="Kim">Won Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] The purpose of this case study was to determine the effectiveness of bandaging
the arm of a patient with secondary lymphedema on the patient’s quality of life, arm
volume and arm function using an additional pad and taping along with some other standard
therapy modalities for lymphedema. [Subjects and Methods] I used a bandage with an
additional pad and taping, along with MLD, exercise, and skin care to treat a patient with
unilateral breast-cancer-related arm lymphedema who had fibrotic tissue on her lower arm
and hand. I made a pad called a “muff” and applied it under tape while using Vodder’s
technique. Treatment was performed during 5 therapy sessions a week for 2 weeks. [Results]
After the physiotherapy sessions, the excess edema volume decreased to 608 ml, and the
percentage of excess volume (PEV) was 9.6%. The therapeutic efficacy, measured as
percentage reduction of excess volume (PREV), was −79.5%, meaning that the edema volume
was reduced 79.5%. The use of an additional pad and taping on a large edematous site with
fibrotic changes can produce more efficacious lymphedema care. [Conclusion] The use of an
additional pad and taping on a large edematous site with fibrotic changes has demonstrated
a positive result in lymphedema management for a post mastectomy patient and, therefore,
further studies on this method are suggested with a larger sample size.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Af" uniqKey="Williams A">AF Williams</name></author><author><name sortKey="Vadgama, A" uniqKey="Vadgama A">A Vadgama</name></author><author><name sortKey="Franks, Pj" uniqKey="Franks P">PJ Franks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woods, M" uniqKey="Woods M">M Woods</name></author><author><name sortKey="Tobin, M" uniqKey="Tobin M">M Tobin</name></author><author><name sortKey="Mortimer, P" uniqKey="Mortimer P">P Mortimer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Forner Cordero, I" uniqKey="Forner Cordero I">I Forner-Cordero</name></author><author><name sortKey="Mu Oz Langa, J" uniqKey="Mu Oz Langa J">J Muñoz-Langa</name></author><author><name sortKey="Forner Cordero, A" uniqKey="Forner Cordero A">A Forner-Cordero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koul, R" uniqKey="Koul R">R Koul</name></author><author><name sortKey="Dufan, T" uniqKey="Dufan T">T Dufan</name></author><author><name sortKey="Russell, C" uniqKey="Russell C">C Russell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pinell, Xa" uniqKey="Pinell X">XA Pinell</name></author><author><name sortKey="Kirkpatrick, Sh" uniqKey="Kirkpatrick S">SH Kirkpatrick</name></author><author><name sortKey="Hawkins, K" uniqKey="Hawkins K">K Hawkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cho, Y" uniqKey="Cho Y">Y Cho</name></author><author><name sortKey="Do, J" uniqKey="Do J">J Do</name></author><author><name sortKey="Jung, S" uniqKey="Jung S">S Jung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kang, Y" uniqKey="Kang Y">Y Kang</name></author><author><name sortKey="Jang, Dh" uniqKey="Jang D">DH Jang</name></author><author><name sortKey="Jeon, Jy" uniqKey="Jeon J">JY Jeon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsai, Hj" uniqKey="Tsai H">HJ Tsai</name></author><author><name sortKey="Hung, Hc" uniqKey="Hung H">HC Hung</name></author><author><name sortKey="Yang, Jl" uniqKey="Yang J">JL Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martins, Jc" uniqKey="Martins J">JC Martins</name></author><author><name sortKey="Aguiar, Ss" uniqKey="Aguiar S">SS Aguiar</name></author><author><name sortKey="Fabro, Ea" uniqKey="Fabro E">EA Fabro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Taylor, R" uniqKey="Taylor R">R Taylor</name></author><author><name sortKey="Jayasinghe, Uw" uniqKey="Jayasinghe U">UW Jayasinghe</name></author><author><name sortKey="Koelmeyer, L" uniqKey="Koelmeyer L">L Koelmeyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ramos, Sm" uniqKey="Ramos S">SM Ramos</name></author><author><name sortKey="O Onnell, Ls" uniqKey="O Onnell L">LS O’Donnell</name></author><author><name sortKey="Knight, G" uniqKey="Knight G">G Knight</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Szuba, A" uniqKey="Szuba A">A Szuba</name></author><author><name sortKey="Achalu, R" uniqKey="Achalu R">R Achalu</name></author><author><name sortKey="Rockson, Sg" uniqKey="Rockson S">SG Rockson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Sf" uniqKey="Liao S">SF Liao</name></author><author><name sortKey="Huang, Ms" uniqKey="Huang M">MS Huang</name></author><author><name sortKey="Li, Sh" uniqKey="Li S">SH Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bernas, Mj" uniqKey="Bernas M">MJ Bernas</name></author><author><name sortKey="Witte, Cl" uniqKey="Witte C">CL Witte</name></author><author><name sortKey="Witte, Mh" uniqKey="Witte M">MH Witte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcneely, Ml" uniqKey="Mcneely M">ML McNeely</name></author><author><name sortKey="Magee, Dj" uniqKey="Magee D">DJ Magee</name></author><author><name sortKey="Lees, Aw" uniqKey="Lees A">AW Lees</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, Tw" uniqKey="Huang T">TW Huang</name></author><author><name sortKey="Tseng, Sh" uniqKey="Tseng S">SH Tseng</name></author><author><name sortKey="Lin, Cc" uniqKey="Lin C">CC Lin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Korpan, Mi" uniqKey="Korpan M">MI Korpan</name></author><author><name sortKey="Crevenna, R" uniqKey="Crevenna R">R Crevenna</name></author><author><name sortKey="Fialka Moser, V" uniqKey="Fialka Moser V">V Fialka-Moser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chou, Yh" uniqKey="Chou Y">YH Chou</name></author><author><name sortKey="Li, Sh" uniqKey="Li S">SH Li</name></author><author><name sortKey="Liao, Sf" uniqKey="Liao S">SF Liao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcwayne, J" uniqKey="Mcwayne J">J McWayne</name></author><author><name sortKey="Heiney, Sp" uniqKey="Heiney S">SP Heiney</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28744063</article-id><article-id pub-id-type="pmc">5509607</article-id><article-id pub-id-type="publisher-id">jpts-2017-126</article-id><article-id pub-id-type="doi">10.1589/jpts.29.1272</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Study</subject></subj-group></article-categories><title-group><article-title>The effects of bandaging with an additional pad and taping on secondary arm
lymphedema in a patient after mastectomy</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Do</surname><given-names>Junghwa</given-names></name><degrees>DPT, CLT, PhD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jeon</surname><given-names>JaeYong</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Won</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. JaeYong Jeon, Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine: 88 Olympic-ro, 43-gil, Songpa-gu, Seoul 05505,
Republic of Korea. (E-mail: <email xlink:href="jyjeon71@gmail.com">jyjeon71@gmail.com</email>)</corresp></author-notes><pub-date pub-type="epub"><day>15</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="ppub"><month>7</month><year>2017</year></pub-date><volume>29</volume><issue>7</issue><fpage>1272</fpage><lpage>1275</lpage><history><date date-type="received"><day>10</day><month>3</month><year>2017</year></date><date date-type="accepted"><day>30</day><month>4</month><year>2017</year></date></history><permissions><copyright-statement>2017©by the Society of Physical Therapy Science. Published by IPEC
Inc.</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0:
<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">https://creativecommons.org/licenses/by-nc-nd/4.0/</ext-link>)</license-p></license></permissions><abstract><p>[Purpose] The purpose of this case study was to determine the effectiveness of bandaging
the arm of a patient with secondary lymphedema on the patient’s quality of life, arm
volume and arm function using an additional pad and taping along with some other standard
therapy modalities for lymphedema. [Subjects and Methods] I used a bandage with an
additional pad and taping, along with MLD, exercise, and skin care to treat a patient with
unilateral breast-cancer-related arm lymphedema who had fibrotic tissue on her lower arm
and hand. I made a pad called a “muff” and applied it under tape while using Vodder’s
technique. Treatment was performed during 5 therapy sessions a week for 2 weeks. [Results]
After the physiotherapy sessions, the excess edema volume decreased to 608 ml, and the
percentage of excess volume (PEV) was 9.6%. The therapeutic efficacy, measured as
percentage reduction of excess volume (PREV), was −79.5%, meaning that the edema volume
was reduced 79.5%. The use of an additional pad and taping on a large edematous site with
fibrotic changes can produce more efficacious lymphedema care. [Conclusion] The use of an
additional pad and taping on a large edematous site with fibrotic changes has demonstrated
a positive result in lymphedema management for a post mastectomy patient and, therefore,
further studies on this method are suggested with a larger sample size.</p></abstract><kwd-group><kwd>Breast neoplasms</kwd><kwd>Lymphedema</kwd><kwd>Quality of life</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Upper-extremity lymphedema after breast cancer surgery is one of the most disruptive
symptoms to a patient’s daily life<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>.
Lymphedema is defined as the abnormal accumulation of protein-rich fluid in extracellular
spaces, caused by decreased lymphatic transport capacity and an increased lymphatic
load<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. Upper-extremity lymphedema after
a mastectomy is the most complained-about symptom of breast cancer treatment. Both surgery
and radiotherapy, involving lymph drainage routes of the breast and axillary areas, are
causes of the development of lymphedema<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>.
Lymphedema can appear as swelling of the arm, hand, trunk, or breast. It can lead to pain
and a sensation of heaviness in the affected area. These symptoms can affect physical
functions and also cause psychological distress<xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>. Consequently, it decreases the patient’s quality of life.</p><p>Currently, the standard care for lymphedema consists of complex decongestive physiotherapy
(CDP), which includes manual lymphatic drainage (MLD), bandaging, therapeutic exercise, skin
care, and offering precautions about daily activities<xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>. Several studies have reported that physical therapy reduces the
volume of the lymphedematous limb and improves the patient’s quality of life<xref rid="r6" ref-type="bibr">6</xref>, <xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>.
Sites that have additional fibrotic tissue require the application of greater pressure on
the affected area than for edema alone. Therefore, pads made from short stretch bandages are
commonly applied to the area first, then surrounded by multilayer inelastic lymphedema
bandaging. This increases the resting pressure as well as the working pressure on the site,
and also reducing the apparent volume of the arm.</p><p>Clinically, we formed the pads from short-stretch bandages. However, only one study has
been conducted regarding the effects of this type of pad, and it was the case of edema only
of the hand<xref rid="r8" ref-type="bibr">8</xref><sup>)</sup>. Taping is a recent
consideration for lymphedema. Kinesio tape (Kinesio Holding Company, Albuquerqe, NM, USA) is
elastic tape which can be stretched up to 120–140% of its original length, invented by Kenzo
Kase in 1996. Kinesio tape can create space between the skin and muscle, which increases the
lymph uptake<xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>. Kinesio tape has been
reported to be safe for patients with lymphedema, offering them improved function in their
daily lives<xref rid="r10" ref-type="bibr">10</xref><sup>)</sup>.</p><p>We describe below a case regarding a patient with unilateral arm lymphedema, for whom we
used an additional pad and taping on the lower arm using short-stretch bandages. Ethnic
approval was received from Asan Medical Center (IRB number: 2015-796)</p></sec><sec id="s2"><title>CASE REPORT</title><p>A 69-year-old female with a medical history of right breast cancer had been diagnosed in
2010. She had had a radical mastectomy modified with axillary lymph node dissection and wide
excision. She had received regular chemotherapy 8 times and undergone radiation therapy. She
reported that she hadn’t had lymphedema after surgery. She developed lymphedema 3 months ago
before her recent visit to the hospital. She said that she had peeled garlic for 7
consecutive hours 1 week before the lymphedema appeared. She visited our clinic due to the
progressive swelling and fibrosis of her right arm that had by then lasted for months was
disrupting her daily activities.</p><p>Upon physical examination, stage II lymphedema and fibrosis of the right forearm was found
(<xref ref-type="fig" rid="fig_001">Fig. 1</xref><fig orientation="portrait" fig-type="figure" id="fig_001" position="float"><label>Fig. 1.</label><caption><p>Status of a lymphedema before treatment</p></caption><graphic xlink:href="jpts-29-1272-g001"></graphic></fig>). A complete laboratory work-up and imaging studies were unremarkable for infection
or venous obstruction of the right arm. The results of lymphoscintigraphy showed that her
right axillary lymph node uptake was not observed and diffuse increased uptake by dermal
backflow had appeared. I arranged 5 therapy sessions a week for her for 2 weeks. In every
therapy session over a total of 10 sessions, 30 minutes of MLD was performed by one physical
therapist certified in the Vodder’s technique which is known as lymphatic massage technique.
The same therapist made a short-stretch bandage pad and applied it to the patient. The pad
was made by the physical therapist. According to the Vodder School, this pad is called a
“muff.” A stockinette was cut into a 1 × 1 cm square piece of Rosidal soft bandage placed
inside it, then the stockinette’s edges were stitched together. The pad was put on the
patient’s lower arm and dorsum before another Rosidal soft bandage was applied. Kinesio tape
was applied to the hand, arm, and trunk. The Kinesio tape used was designed to make a 30–40%
longitudinal stretch. The patient did 20 therapeutic exercises to facilitate venous and
lymphatic flow, and received instructions for skin and nail care. Exercises included an
active range of motion of upper extremity and deep breathing exercise. The short stretch
bandage was kept on for 23 hours and replaced at the next day.</p><p>Circumferential measurements were taken at every 4 cm from the wrist to the axilla, and at
the dorsum to below 4 cm from the wrist, using the formula ∑ Circumference<sup>2</sup>/π<sup>3</sup>. The measurements were made before the beginning of the treatment and after
2 weeks of treatment<xref rid="r11" ref-type="bibr">11</xref><sup>)</sup>. The severity of
the lymphedema was defined as the percentage of excess volume (PEV) or the excess lymphedema
volume relative to the healthy arm: PEV=((volume of lymphedema arm −volume of healthy arm)/
(volume of healthy arm)) × 100%. The response to the therapeutic intervention was quantified
as the percentage reduction of excess volume (PREV): PREV=100% × (posttreatment volume of
lymphedema arm − baseline volume of lymphedema arm)/ excess volume.</p><p>The initial excess volume was 764 ml, and the lymphedema severity-baseline PEV was 47.1%,
which indicated severe lymphedema, based on the definition from the International Society of
Lymphology. After the 10 physiotherapy sessions, the excess volume decreased by 608 ml, and
PEV was 9.6%. The therapeutic efficacy, PREV, was −79.5%, meaning that the edema volume
could be reduced by 79.5% after 10 sessions of therapy (<xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>Volume reducation</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" rowspan="1" colspan="1">Variable</th><th align="center" valign="middle" rowspan="1" colspan="1">Baseline</th><th align="center" valign="middle" rowspan="1" colspan="1">Post-10-Time<break></break>Treatment</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Excess volume (EV)</td><td align="center" rowspan="1" colspan="1">764 ml</td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Post-t/x decreased EV, ml</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">–608 ml</td></tr><tr><td align="left" rowspan="1" colspan="1">PEV, %</td><td align="center" rowspan="1" colspan="1">47.1%</td><td align="center" rowspan="1" colspan="1">9.6%</td></tr><tr><td align="left" rowspan="1" colspan="1">PREV, %</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">–79.5%</td></tr></tbody></table><table-wrap-foot><p>PEV: percentage of excess volume; PREV: percentage reduction of excess volume</p></table-wrap-foot></table-wrap>) (<xref ref-type="fig" rid="fig_002">Fig. 2</xref><fig orientation="portrait" fig-type="figure" id="fig_002" position="float"><label>Fig. 2.</label><caption><p>Status of a lymphedema on dorsum after treatment</p></caption><graphic xlink:href="jpts-29-1272-g002"></graphic></fig>).</p><p>The patient followed the entire course of treatment well. After 2 weeks, the score for her
quality of life (QOL) question in the EORTC QLQ-C30 questionnaire improved to 100, compared
to a baseline score of 50 baseline. Also, the score for her disabilities of the arm,
shoulder and hand (DASH) also improved (<xref rid="tbl_002" ref-type="table">Table
2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>QOL and arm function</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1">Baseline</th><th align="center" valign="middle" rowspan="1" colspan="1">Post-10-Time<break></break>Treatment</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">EORTC QLQ-C30<sup>*</sup></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Global health status/QOL</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">100</td></tr><tr><td align="left" rowspan="1" colspan="1">DASH</td><td align="center" rowspan="1" colspan="1">47.5</td><td align="center" rowspan="1" colspan="1">15</td></tr></tbody></table><table-wrap-foot><p>*Quality of life questionnaire-cancer. DASH: disabilities of the arm, shoulder and
hand</p></table-wrap-foot></table-wrap>).</p></sec><sec sec-type="discussion" id="s3"><title>DISCUSSION</title><p>This patient’s PEV improved from 47.1 to 9.6% after therapy, from severe lymphedema to
minimal lymphedema. The lymphedema reduction was 79.5% after 10 sessions of therapy;
therefore the lymphedema treatment was successful, as per Ramos’s definition. According to
Ramos, S. M. et al., the definition of successful lymphedema treatment is a mean reduction
of 50% or more of pre-treatment edema fluid volume<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>. In this case, the result was as good as those in previous studies,
which have demonstrated that the CDP program can reduce fluid volume<xref rid="r13" ref-type="bibr">13</xref>, <xref rid="r14" ref-type="bibr">14</xref><sup>)</sup>. I wished to
determine if the additional pad contributed further to the positive results of this
treatment.</p><p>The role of MLD by itself as a treatment method for lymphedema is still controversial in
breast cancer related lymphedema (BCRL) studies. Bergmann, A. et al. reported that MLD did
not significantly increase the therapeutic response in women with lymphedema after breast
cancer<xref rid="r15" ref-type="bibr">15</xref><sup>)</sup>. McNeely et al. showed MLD
only had an effect on mild early-stage lymphedema<xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>. Based on the results of the meta-analysis, Huang, T. W. did not
recommend the addition of MLD to compression therapy for patients with breast-cancer-related
lymphedema<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup>. Though he/she
demonstrated that exercises improve mobility and muscular activity and lead to the internal
compression of lymph vessels, and that intermittent pressure changes between muscles and
external compression (bandages or compressive garments) stimulate lymph drainage, Korpan et
al. who studied the effects of exercise on lymphedema, concluded that further research is
needed<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup>.</p><p>A specific application of additional pads combined with Kinesio tape may assist improve the
effect of conventional lymphedema management using the MLD and/or the CDP. As this study
suggested the effect of the standard CDP may be enhanced when it follows the Vodder’s school
method and combined with Kinesio tape. The strongest contributor for the enhancement was
probably the specific application method of the compression pads. Compression therapy using
a multilayer bandage acts by modifying the capillary dynamics of veins, lymph vessels and
tissues. It promotes increased interstitial pressure and increased ability of muscle and
joint pumping. Foldi said that CDP would not be successful if the patients were not able to
cooperate with the compression therapy<xref rid="r19" ref-type="bibr">19</xref><sup>)</sup>.
The compression therapy on its own should be considered as a part of the treatment option in
reducing arm lymphedema volume, while additional taping should be considered for further
decreasing the fluid volume.</p><p>Many researchers have discussed the various physiological symptoms of lymphedema. One study
measured 11 lymphedema-related symptoms, such as sensations of pain, discomfort, heaviness,
fullness, bursting, hardness, heat, cold, numbness, weakness, and tingling to evaluate the
effects of intervention<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. The patient in
this case also felt discomfort, heaviness, fullness, and hardness. The impact of lymphedema
on QOL ranges from subtle to drastic, and sequelae include frustration, distress,
depression, and anxiety, particularly with regard to body image<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>. Therefore, this patient’s quality of life (QOL) was
affected both physically and psychologically. After her lymphedema status improved, her DASH
score also improved compared to her baseline evaluation. Therefore the improvement of her
symptoms most likely positively affected her quality of life.</p><p>The use of an additional pad and taping underneath a compression bandage had an excellent
effect on this case of secondary arm lymphedema. A large-sample study may further clarify
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