Este ensaio clínico randomizado publicado em 2010, fala sobre a formação do seroma pós cirurgias de mama e coloca o linfotaping como uma opção de tratamento com bons resultados.

1. Clinical RESEARCH/AUDIT
Lymph taping and seroma
formation post breast cancer
Joyce Bosman, Neil Piller
Abstract
Background: The most common complication of breast cancer treatment is seroma formation. Lymph taping has the
potential to prevent or reduce seroma formation, but currently its potential benefits have not been fully investigated.
Aims: To investigate the potential of lymph taping to combat seroma formation. Methods: Nine women treated for breast
cancer were recruited to this randomised clinical trial; four developed seromas requiring aspiration. Bio-impedance
spectroscopy of the breast was used to assess intra and extracellular fluid levels in each of the four quadrants of the
breast. From day one postoperatively, lymph taping was applied over the watershed between skin territories on the
posterior thorax between the spine and axilla on those allocated to the treatment group. Measurements were repeated
at five, nine and 16 days. Results: The extracellular fluid value at t16 was 0.1037 ± 0.0324 (15.3 % decrease) over t1 in the
lymph taping group and 0.1066 ± 0.0227 (4.6 % decrease) in the current best practice group (n=4 in each group). After
16 days of treatment, substantial changes were found in burning sensations, tightness and heaviness in favour of the lymph
taping group. In particular, pain perception in the lymph taping group improved. Conclusions: This study has demonstrated
that lymph taping has the ability to reduce extracellular fluid accumulation and improve a range of quality of life measures.
seroma formation after breast surgery of the investigated criteria suggested
Key words varies between 2.5% and 51% (Brayant that:
and Baum, 1987; Barwell et al, 1997; 8 Seroma is not an accumulation of
Breast cancer Woodworth et al, 2000). Vitug and serum, but an exudate
Lymphoedema Newman (2007) report that 10% to 8 Exudate is an element in an acute
Seroma formation 80% of ALND and mastectomy cases inflammatory reaction, i.e. the first
Lymph taping require seroma aspiration. phase of wound repair
8 Seroma formation reflects
Various methods have been an increased intensity and a
used to prevent seroma formation. prolongation of this repair phase.
However, the use of lymph taping
B
reast cancer surgery is treated in this context has not been fully Watt-Boolsen et al (1989) also
with either modified radical evaluated in the current literature. posited that the predominant white
mastectomy (MRM), wide local cells present in a seroma were
excision (WLE) and axillary lymph Seroma granulocytes rather than lymphocytes,
node dissection (ALND), or sentinel Seroma is defined as a serous fluid indicating that the fluid is likely to be
lymph node biopsy (SLNB). Common collection that develops under the exudate. The protein concentration
complications of breast surgery skin flaps during mastectomy or in in seromas was found to be more
include bleeding, infection, lymph the axillary dead space after axillary consistent with that of an exudate
oedema and nerve damage (Leica and dissection (Pogson et al, 2003). produced as a result of acute
Apantaku, 2002). The most common Seroma formation generally begins on inflammation during wound healing
complication following breast surgery the seventh day post surgery, reaches (Watt-Boolsen et al, 1989).
is seroma formation. Incidence of a peak rate of growth on the eighth
day and slows continuously until Gardner et al (2005) suggests
the sixteenth day when it generally that there are seven causative factors
Joyce Bosman is an oedematherapist at Medisch Centrum resolves (Menton and Roemer, 1990). contributing to seroma formation:
Zuid, Groningen, the Netherlands; Neil Piller is a Professor 8 Poor adherence of flaps to
and Director of the Lymphoedema Assessment Clinic, Watt-Boolsen et al (1989) found chest wall
Department of Surgery, Flinders University and Medical that the composition of the fluid and 8 Division of several larger lymph
Centre, South Australia aspirates and the time-related changes trunks
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2. Clinical RESEARCH/AUDIT
8 Large dead space/large raw area in when symptomatic (Anand et al, immobilisation of the shoulder until
the axilla 2002). In some cases, the fluid day seven postoperatively significantly
8 Pump action of upper limb collection may recur so this may need reduced the incidence of seroma.
increasing lymph flow to be done more than once (Cancer However, other authors describe
8 Local inflammatory mediators, Society of New Zealand, 2003). how immobilisation of the upper
8 Irregular shape of chest wall Seromas can generally be managed by limb generated unacceptable rates of
and axilla one to six aspirations (Gonzalez et al, frozen shoulder and, therefore, advise
8 Shear forces during respiration. 2003). However, the use of fine needle early shoulder exercises. Evidence for a
aspiration to assess changes in an clear role of immobilisation in seroma
Although seromas are not life- oedematous breast can be problematic prevention is still lacking (Gardner et
threatening, they can lead to significant and may, in itself, produce additional al, 2005).
morbidity (e.g. flap necrosis, wound inflammation and oedema (Williams,
dehiscence, predisposition to sepsis, 2006). Postoperative breast seroma,
impaired shoulder function [muscle therefore, is an important cause of
strength weakness], prolonged morbidity that continues to cause
recovery period and multiple physician Although seromas are difficulties for surgeons and for which
visits) and may delay adjuvant therapy not life-threatening, they the best treatment has long been
(Budd et al, 1978; Aitkin and Minton, can lead to significant debated (Gardner et al, 2005).
1983; Gardner et al, 2005).
morbidity (e.g. flap
The use of taping for the
Extensive dissection generates a necrosis, wound dehiscence, management of seroma is gaining
considerable potential space as breast predisposition to sepsis, popularity and while there is significant
tissue is removed and lymphatic impaired shoulder clinical experience of this approach,
vessels are severed allowing lymph function [muscle strength there is little published research.
to pass into the dead space. The weakness], prolonged Lymph taping is a part of the Medical
distensibility of the skin flaps raised Taping Concept, which is believed
recovery period and
during the surgery further establishes to contribute to the stimulation and
a potential space in which fluid can multiple physician visits) improvement of lymphatic drainage
collect. In addition, axillary lymph node and may delay adjuvant (www.medicaltaping.com).
dissection results in the division of therapy.
several larger lymph trunks, and when Lymph taping
the arm is mobilised post-operatively, In its most common application,
the upper-limb musculature acts as a Several interventions have been lymph taping is applied to the poorly
pump, increasing lymph flow (Gardner reported with the aim of reducing draining area (lymphatic territory) of
et al, 2005). seroma formation including the use the lymphoedematous limb or area.
of pressure garment and prolonged The special tape used has an elasticity
It is common for people who have limitation of arm activity. However, it similar to that of the skin and is similar
had their lymph nodes removed to has been suggested that the use of in weight to the epidermis. By applying
experience fullness under the arm these interventions not only reduces the tape in a proximal to distal
after the drain(s) has been removed. seroma formation, but may also direction and positioning the body in
Evidence on the effect of drains on increase the incidence of seroma a way that the tape is stretched during
seroma formation is inconclusive formation after removal of the drain application, the lymphatic drainage
(Gardner et al, 2005). People often (O’Hea et al, 1999), and even might system is stimulated 24 hours a day.
describe seroma as like ‘having a ball cause shoulder dysfunction (Dawson
fixed into their armpit’. et al, 1989). The tape must be applied in
accordance with the anatomy of
Following a modified radical Seroma formation after breast the lymph flow. The tape lifts the
mastectomy it is also possible to cancer surgery occurs independently skin slightly, opening the lumen of
develop seroma on the chest wall. of drainage duration, compression the lymph angioma and reducing
As with a haematoma, this fluid is dressing and other known prognostic the pressure on the blood vessels.
reabsorbed by the body over time. factors in breast cancer patients Moreover, the tape acts as a conductor
except the type of surgery, i.e. there of interstitial fluid, moving fluids from
Persistent seromas have is a 2.5 times higher risk of seroma areas of higher pressure towards
traditionally been treated with formation in patients who undergo areas of lower pressure (Kase et al,
repeated aspirations, local pressure a modified radical mastectomy 2003). The tape may also influence
dressings, and occasionally surgical compared to breast-conserving the deeper lymphatic system and
ablation (Gardner et al, 2005). surgery (Hashemi et al, 2004). Schultz encourage myofascial release,
Seromas should only be aspirated et al (1997) were able to show that enhancing drainage in the subfascial
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3. Clinical RESEARCH/AUDIT
lymphatics (although this remains to Flinders University and Medical Centre performed, tumour size, number
be proven). Clinical Research Ethics Committee of lymph nodes removed, number
prior to commencing the study. of lymph nodes infiltrated and the
Shim et al (2003) posit that frequency and number of aspirations.
endothelium may act as a micro-valve Nine women who had undergone Bio-impedance and QoL was
along the walls of the initial lymphatics. surgical treatment for their measured on day one postoperatively
These valves open during any breast cancer (± radiotherapy ± (t1), day five postoperatively (t5), day
stretching of the lymphatics and during chemotherapy) were recruited for nine postoperatively (t9) and day 16
the influx of interstitial fluid into the this clinical trial. Before surgery (t0), postoperatively (t16).
lumen, while anchoring filaments keep participants were measured using bio-
the endothelial cells tightly attached impedance spectroscopy and filled out
to the adjacent collagen network. a quality of life (QoL) questionnaire. Table 1
Expansion of the initial lymphatics A patch test was also performed
causes the interstitial fluid to fill the to ensure the participants were Between subject reproducibility:
open endothelial micro-valves through not allergic to the tape material or bio-impedance measurements
percolation, while compression causes adhesive. (Moseley and Piller, 2008)
closure of the endothelial micro-
valves and outflow along the lumen After surgery, participants were Position Covariance
of the micro-lymphatics, with eventual divided in two groups, a lymph taping (%)
transport to collecting lymphatics. group and a current best practice Affected Breast
Reflux towards the initial lymphatics is group 8 Upper outer quadrant (R0a) 0.34%
prevented by bicuspid valves. 8 Upper inner quadrant (R0) 0.24%
Starting on day one postoperatively, 8 Lower outer quadrant (R0) 0.24%
Bio-impedance lymph taping was applied every five 8 Lower inner quadrant (R0) 0.53%
A promising technique in measuring days to the lymph taping group. The 8 Upper outer quadrant (Rfb) 0.40%
breast changes is bio-impedance. tape was cut into three strips and 8 Upper inner quadrant (Rf) 0.48%
Local bio-impedance uses electrical applied over the watershed between 8 Lower outer quadrant (Rf) 0.86%
currents to measure the impedance the posterior thoracic skin territories 8 Lower inner quadrant (Rf) 0.54%
of the tissue and, therefore, the fluid and from spine to axilla (Figure 1).
volume. This type of technique has The patient was positioned so that Normal Breast
been previously used to measure the skin was slightly stretched before 8 Upper outer quadrant (R0) 0.20%
arm lymphoedema (Cornish et al, the application of the tape. Once the 8 Upper inner quadrant (R0) 0.36%
2001; Box et al, 2002), breast fluid skin returned to its normal position, it 8 Lower outer quadrant (R0) 0.48%
volume (Mosely and Piller, 2008), was drawn up to create an underlying 8 Lower inner quadrant (R0) 0.33%
and breast tumours (Ohmine et al, negative pressure (Williams, 2006). 8 Upper outer quadrant (Rf) 0.38%
2000). As demonstrated in Table 1, 8 Upper inner quadrant (Rf) 0.45%
the covariance for bio-impedance The participants were encouraged 8 Lower outer quadrant (Rf) 0.39%
measurements is quite low, ranging to perform early arm motion, including 8 Lower inner quadrant (Rf) 0.32%
from 0.20–0.86%, demonstrating that abduction of the arm at 90° and a R0 represents the extracellular fluid
the between subject reproducibility arm raising. Participants were also measurement
is consistent and therefore reliable encouraged to resume their normal b Rf represents both the intra and
(Mosely and Piller, 2008). daily activities (Gonzalez et al, 2003). extracellular measurement
General advice was provided to
Rationale participants regarding skincare, e.g.
This study was undertaken to how to wash and dry the skin, to avoid
determine the effect of lymph taping using warm air to dry the tape and to
on post-operative seroma following seek advice if problems occurred.
breast cancer surgery. Most of the
literature is based on the effect of In both the current best practice
lymph taping in oedema of the arm. group and the lymph taping group,
However, the use of lymph taping for seroma aspirations were taken using
seroma management does not appear techniques currently approved by the
to be considered, even though there Department of Surgery, at Flinders
are similarities in the nature of the University and Medical Centre.
fluid accumulation.
Parameters collected from the Figure 1. Lymph taping over the watershed between
Method sample groups included age, body the posterior thoracic skin territories from the
Ethical approval was obtained from mass index (BMI), type of surgery spine to axilla.
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4. Clinical RESEARCH/AUDIT
Outer edge
of breast Table 2
Half way point
Characteristics of the participants
Subject Age (years) Weight Height (cms) BMI *
(kgs)
Nipple Mean 57.5 66.8 162 25.5
Standard Deviation 13.0 11.5 5.8 4.1
Figure 2. Breast quadrants and halfway point. * Body Mass Index calculated as weight (kgs) / height (m2)
Allocation to either the treatment
group or the current best practice their volume index and work out participants with a tumour diameter
group was performed by the toss of a the actual volume (ECF volume = less than 25mm and in three of the
coin for the first patient — subsequent pECF*L^2/R0). A P value of <0.05 five with a tumour diameter greater
participants were then allocated to was considered significant. than 25mm.
each group alternately.
Results There were two grade I tumours
Local bio-impedance Nine women who had treatment (25%), three grade II (37.5%), and two
The fluid impedance of each breast for their breast cancer entered the grade III (25%). In one patient there
quadrant was measured using the study but one was excluded due to a were no tumour grade details listed.
Impedimed® Imp SFB7 bio-impedance prolonged surgical intervention. The There were two seromas requiring
unit (Impedimed). The electrodes mean age of the women was 57.5 aspiration in the grade II tumour group
were placed in a straight line along the years with a range of 41–79 years. and one in the grade III tumour group.
halfway point of the breast (Figure 2) Four participants had undergone MRM,
and a multi-frequency current (5-500Hz) while the other four had undergone The model number of lymph nodes
was applied through the electrodes WLE. Six were also treated with removed was 10 ± 6 (range 1–15).
to measure the fluid impedance. ALND, while a further two underwent Four participants (50%) had positive
The measurement data was then a SLNB. Table 2 displays the group lymph nodes, while three of the four
downloaded and stored in a laptop. demographic and anthropometric developed seromas that needed
characteristics. aspiration.
Analysis
All data was analysed using SPSS®. Closed suction drainage was used The bio-impedance figure (see
All results are expressed as means ± in all participants and the carcinoma Analysis section above for explanation)
standard deviation in tables. Paired was invasive in all of the participants. representing the mean volume of
t-tests were used to compare the Four participants developed seromas extracellular fluid (ECF) at t0 was
extracellular fluid (ECF) volume and that required aspiration — three of 0.0868 ± 0.0106 and 0.0858 ± 0.0182
QoL with and without lymph taping. these had undergone MRM and one for lymph taping and current best
The ECF volume was determined had undergone WLE. All were treated practice groups respectively. At one
using the formula: with ALND. day postoperatively the mean volume
of ECF was 0.1224 ± 0.0279 (a 41%
ECF volume index = L^2/R0 Two of the four participants who increase) and 0.1118 ± 0.0083 (a
(where ‘L’ is the length and R0 is the developed seromas were treated 30% increase) respectively for the
value measured by the bio-impedance with lymph taping, while the other lymph taping and current best practice
device) two received current best practice, groups. Taping was commenced after
including general skin and limb this first postoperative measure.
Because the resistivities for care advice and a gentle exercise
extracellular fluid (ECF), intracellular programme. The mean amount of The mean volume of ECF on
fluid (ICF) and total body fluid (TBF) aspirate was 175.82 ± 109.29ml day five was 0.1189 ± 0.0308 (2.9%
are not known, the authors could not (range 20–335ml). The number of decrease) and 0.1165 ± 0.0181 (4.3%
draw interferences about the relative aspirations ranged from 2–5. increase) respectively for the lymph
amounts. Nevertheless, it was possible taping and current best practice
to draw conclusions from the trend The mean tumour diameter of groups.
in each. If the resistivity of ECF in the all participants was 33.63±14.59mm
breast quadrants is ever measured in (range 13–50mm). Seromas required On day 9 this volume was 0.1302
the future, the authors could multiply aspiration in one of the three ± 0.2922 (6.4% increase) and 0.1190
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5. Clinical RESEARCH/AUDIT
current best practice results in an
Table 3 increase in volume of ECF.
Extracellular fluid Quality of life was scored on seven
variables (Table 4). Between t1 and
t5 there was a substantial difference
Randomisation ECF t0 ECF t1 ECF t5 ECF t9 ECF t16 between the lymph taping group
by treatment and current best practice group, but
Current best Mean 0.0858 0.1118 0.1165 0.1190 0.1066 after t5 the variables showed large
practice total SD 0.0182 0.0083 0.0181 0.2059 0.0227 improvements as shown in Figures 3–5.
group n=4 Percentage 30% +4.27% +6.48% –4.59%
Lymph taping Mean 0.0868 0.1224 0.1189 0.1302 0.1037 The subjects’ range of motion
total group n=4 SD 0.0106 0.0279 0.0308 0.2922 0.0324 (ROM) improved during t1 and t16 in
Percentage +41% –2.86% +6.36% –15.32% the lymph taping group. After 16 days
of treatment, substantial improvements
Current best Mean 0.0855 0.1138 0.1260 0.1259 0.1210
were found in burning sensations
practice with SD 0.0235 0.0138 0.0106 0.0274 0.0228
(66.7%), tightness (50%) and heaviness
aspirations n=2 Percentage +33.1% +10.7% +10.6% +6.3%
(100%) in the lymph taping group.
Lymph taping Mean 0.0859 0.1329 0.1409 0.1503 0.1301 However, the ‘ball-like’ feeling increased
with aspirations SD 0.0157 0.0344 0.0278 0.0227 0.0145 by 150% in the current best practice
n=2 Percentage +54.7% +6% +13.1% –2.1% group compared to 250% in the
ECF volume index = L^2/R0 lymph taping group. There was a small
increase in pain (11.1%) in the current
best practice group.
Table 4 Substantial differences were
observed for the pain perception
Quality of life (scored on 10-point visual analog scale [means shown] between the two groups at t0 (P =
.08), t1 (P < .08) and t5 (P < .08).
t0 t1 t5 t9 T16 However at t9 (P < .22) and t16 (P
< .18) this difference was no longer
QoL LT CBP LT CBP LT CBP LT CBP LT CBP substantial, meaning that the pain
Pain 2.75 1.20 4.25 2.25 5.00 1.67 4.50 3.00 4.25 2.50 perception for the lymph taping group
Heaviness 1.50 1.00 1.50 1.00 3.25 1.00 1.75 2.25 2.00 2.00 improved (Table 5). None of these
values were statistically significantly
Tightness 1.00 1.00 2.50 1.50 5.25 1.67 2.75 3.50 2.50 2.25
different, however, a larger study may
Temperature 1.00 1.00 1.00 1.00 2.75 1.00 1.00 1.00 1.00 1.00 show them to be so.
Burning 1.00 1.40 1.00 1.50 1.00 1.00 1.00 2.25 1.00 2.50
sensations Discussion
Seroma is widely accepted as a
Ball-like feeling 2.00 1.00 1.00 1.00 4.25 1.00 2.50 2.25 3.50 1.50
normal complication following breast
ROM 2.75 1.00 5.00 3.50 4.00 2.83 2.50 2.88 1.88 1.75 cancer surgery. Gonzalez et al (2003)
called it a ‘necessary evil’ that occurs
unpredictably in a predictable number
± 0.2059 (6.5 % increase) for lymph 3). By looking at the par ticipants of patients. The authors believe that
taping and current best practice requiring aspirations (two in each of this view of seroma should change.
respectively. On day 16 the mean the current best practice and lymph Every aspiration may cause infection
volume measurement of ECF was taping groups), the mean volume of and, therefore, a higher risk of
0.1037 ± 0.0324 (15.3% decrease) ECF decreased more in the lymph lymphoedema. Seroma should not
and 0.1066 ± 0.0227 (4.6% decrease) taping group. be looked upon as being a normal
respectively for the lymph taping and complication.
current best practice groups. Table 3 shows a mean volume of
0.1301 ± 0.0145 (a 2.1% decrease) The incidence of lymphoedema
These results suggest that and 0.1210 ± 0.0228 (a 6.3% increase) has been evaluated in many
both the shor t term (five days respectively for the lymph taping studies. However, the incidence of
postoperatively) and longer term (16 and current best practice groups on lymphoedema after the presence of
days postoperatively) par ticipants day 16. Thus lymph taping results in a seroma has not yet been evaluated.
benefit from lymph taping (Table a decrease in volume of ECF, while The authors suggest that more
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6. Clinical RESEARCH/AUDIT
research needs to be conducted into ROM
the incidence of lymphoedema after Ball-like
the presence of a seroma. feeling
Burning
sensation
QOL variables
In this study, one patient had Current best practice
Temperature
thyroid problems and developed Lymph taping
a seroma that needed aspiration. Tightness
Although the patient was taking Heaviness
medication, thyroid problems may
be a predisposing factor for seroma Pain
development. Because of the -50 0 50 100 150 200 250 300 350
presence of an oedematherapist Percentage
specialised in lymph taping at the
Figure 3. Quality of life: percentage changes on day one post-op’ versus day five post-op’
breast care unit, this patient was
referred for treatment. In most
ROM
settings this is not the case.
Ball-like feeling
A higher score of ‘ball-like feeling’ Burning
was reported in the lymph taping sensation
QOL variables
Current best practice
group. This might be explained through Temperature
Lymph taping
lymph taping pulling the fluids away Tightness
from one area and allowing them
to accumulate in another (resulting Heaviness
in the ‘ball-like feeling’). If this is the Pain
case it could be seen as a positive
-60 -30 0 30 60 90 120 150
development, i.e. the fluid moving away
Percentage
from the affected area, but perhaps
not far enough. Figure 4. Quality of life: percentage changes on day one post-op’ versus day nine post-op’
The authors continue to seek ROM
methods that will decrease this ‘ball- Ball-like feeling
like feeling’ and suggestions include
Burning
a breathing programme (i.e. to set sensation
QOL variables
Current best practice
up a proximal pressure gradient Temperature
Lymph taping
between this area and the drainage
Tightness
points) or the placement of further
lymph tape to stimulate drainage over Heaviness
the watershed to other lymphatic
Pain
territories.
-100 -50 0 50 100 150 200 250
Before the study, it was Percentage
hypothesised that lymph taping can Figure 5. Quality of life: percentage changes on day one post-op’ versus day 16 post-op’
be a useful and harmless strategy for
the prevention or management of
Table 5
seroma after breast cancer surgery.
This hypothesis was supported as
Quality of life difference between groups (p values indicated)
those participants who received lymph
taping had substantially less seroma on
day 16 than those who received best QOL t0 QOL t1 QOL t5 QOL t9 QOL t16
current practice. However, the authors Pain .080 .076 .072 .215 .180
believe that studies with higher
Heaviness .264 .317 .079 .741 1.000
numbers of participants are required
to demonstrate statistically significant Tightness 1.000 .508 .138 .549 1.000
changes. Nevertheless, there is still Temperature 1.000 1.000 .186 1.000 1.000
a degree of practical significance to
Burning sensations .371 .127 1.000 .317 .317
support this hypothesis. In this study,
the authors demonstrated a decrease Ball-like feeling armpit .264 1.000 .186 .881 .225
in mean volume of extracellular fluid in
Journal of Lymphoedema, 2010, Vol 5, No 2 ??

7. Clinical RESEARCH/AUDIT
the breast. Concurrently, the subjects Cornish BH, Chapman M, Hirst C,
QoL improved on several variables, Mirolo B, Bunce IH, Ward LC, Thomas BJ
(2001) Early diagnosis of lymphedema
including ROM, burning sensations,
tightness and heaviness.
using multiple frequency bio-impedance. Key points
Lymphology 34(1): 2–11
These results suggest that the
Gardner A, Pass HA, Prance S (2005) 8 Frequent complications of
Techniques in the prevention and breast cancer treatment
outcome for participants can be management of breast seroma: An
improved using this relatively easy evaluation of current practice. Women’s
include bleeding, infection,
approach. Oncology Rev 5(3): 135–43 lymphoedema (arm and
breast) and nerve damage, but
Cancer Society of New Zealand (2003)
Conclusion Post-Operative Problems after Breast Cancer the most common is seroma
The optimal way to manage a seroma Surgery. Cancer Society – brief facts. formation.
is unknown. Most clinicians will aspirate Available at: http://66.70.201.199/csw-
latest/html/index.php?url=/csw-latest/html/ 8 Lymph taping has the potential
a symptomatic seroma and thereafter patient/cs_patient_01_facts.php (accessed
only re-aspirate if the seroma re- to reduce seroma formation
27 August, 2010)
appears. Usually this is indicated by but currently its potential
the patient or the breast nurse (on
Dawson I, Stam L, Heslinga JM, benefits in this context have
Kalsbeck HL (1989) Effect of shoulder not been fully investigated.
re-examination). In our opinion, the immobilization on wound seroma and
risk of additional inflammation and shoulder dysfunction following modified
8 This study used bio-impedance
associated increased oedema is not radical mastectomy: a randomized
prospective clinical trial. Br J Surg 76: spectroscopy of the breast,
acceptable with this invasive technique.
311–12 on the side of the surgery, to
This pilot study has demonstrated
Gonzalez EA, Saltzstein EC, Riedner CS, assess intra and extracellular
that Lymph Taping has the potential
Nelson BK (2003) Seroma formation fluid levels in each of the four
to become a non invasive method
following breast cancer surgery. Breast J quadrants of the breast. A
to manage seroma. However, further 9(5): 385–8 questionnaire measuring quality
controlled trials need to be conducted
Hashemi E, Kaviani A, Najafi M, Ebrahimi of life was administered.
to confirm this. JL
M, Hooshmand H, Montazeri A (2004)
Seroma formation after surgery for breast 8 The study also used a
Acknowledgement cancer. World J Surg Oncol 2: 44
questionnaire to measure
The CureTape® used in this study
Kase K, Wallis J, Kase T (2003) Clinical quality of life.
was funded by FysioTape B.V. the Therapeutic Applications of the Kinesio
Netherlands. Taping Method. Kinesio Taping Association,
8 The study showed that lymph
Tokyo
taping has the ability to reduce
Leica M, Apantaku MD (2002) Breast- extracellular fluid accumulation
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