Physical Therapy Intervention to Augment Outcomes of Lymph Node Transfer Surgery for a Breast Cancer Survivor with Secondary Upper Extremity Lymphedema: A Case Report.

Abstract

Background and purpose: Lymphedema is an incurable complication of breast cancer treatment that affects roughly 20% of women. It is traditionally managed via complete decongestive therapy, which includes manual lymph drainage, therapeutic wrapping, compression garments, skin care, and exercise. Lymph node transfer is a new surgical intervention that uses one’s own lymph nodes and implants them in the affected upper extremity. The purpose of this case report was to describe the outcomes of a complex decongestive physical therapy program that augments lymph node transfer by directing lymph fluid toward the surgical flap in a patient with secondary lymphedema.

Case Description: A 65-year-old female presented with secondary upper extremity lymphedema following breast cancer treatment. Her circumferential measurements and L-Dex score corroborated this diagnosis, and she also had deficits in upper extremity range of motion. She was seen for 34 visits over the course of six months for complete decongestive therapy.

Outcomes: At six months, the patient’s circumferential measurements and L-Dex scores showed a meaningful increase in limb girth. She had minor improvements in the FACIT-F, DASH, ROM, and upper extremity strength.

Discussion: The surgical intervention supplemented by complete decongestive therapy resulted in increased limb girth six months after surgery. The patient’s circumferential measurements, although elevated, may have stabilized over time and she was able to stop wearing her compression sleeve while continuing manual lymph drainage and upper extremity wrapping at home. Further research is needed to determine the long-term effects of this surgery coupled with physical therapy intervention, and whether it has better outcomes than the standard conservative treatment of complete decongestive therapy alone.