A prospective randomised study of alginate-drenched low stretch bandages as an alternative to conventional lymphologic compression bandaging.
BACKGROUND
Breast-cancer-related lymphoedema, either caused by the tumour itself or its therapy, can be found in approximately 24% of all patients. It results in disabilities, psychological distress and reduced quality of life. Therefore, proper therapy for this entity is very important. Guidelines recommend a therapy in two phases, an intensive phase I for 3 weeks for volume reduction and, between the cycles of phase I, a reduced phase II to maintain the result. During phase I therapy, manual lymphatic drainage often cannot be administered on weekends or holidays; only a reduced therapy, mainly by application of a more or less passive compression by bandaging, is administered. For this, conventional low-stretch bandages are hitherto being used. Several attempts have been made to overcome this disadvantage by either impregnating or covering the bandage with sticky or adhesive substances such as india rubber, elastomeres, polyacrylates, etc. Recently, new bandages are available, which are drenched with alginate that becomes semi-rigid after drying for approximately 6 h. It was the aim of this study to compare alginate bandaging to a conventional lymphologic-multilayered low-stretch bandaging with individual supportive lining as to their effect concerning their congestive capacity in exactly delimited time periods of reduced decongestive therapy as well as the patients' tolerance.


METHODS
From December 2007 until May 2008, 61 female patients with a one-sided lymphoedema of the axillary tributary region after axillar dissection who underwent a phase I complex decongestive therapy were prospectively selected for our investigation. On weekends, group A got the conventional low-stretch compressive bandaging, whereas group B got an alginate semi-rigid bandage. Arm volumes were measured before and after these bandages were applied. Additionally, the subjective sensations of the skin caused by the compression were measured by means of a five-level Likert scale.


CONCLUSIONS
The initial volumes (V (0)) of the two groups (A, 2,939.0 ml +/- 569.182; B, 3,062.6 ml +/- 539.161) varied within the same magnitude, with somewhat smaller values in group A. The same was true for the final volumes (V (6)), measured at day 22 (A, 2,674.5 ml +/- 480.427; B, 2,740.1 ml +/- 503.593). During the weekends, the arm volumes re-increased (first weekend: A, 16.4 ml vs. B, 4.7 ml; second weekend: A, 14.2 ml vs. B, 2.7 ml; third weekend: A, 7.5 ml vs. B, 1.1 ml). A significantly smaller volume increase appeared in the alginate group during the weekends. There were no serious side effects in both groups. Concerning the patients' comfort, the values of the alginate group were clearly better than those of the conventionally bandaged group. Additionally, the volume changes in the alginate group revealed fewer fluctuations. As a summary, one can state that a good alternative to the conventional bandaging is available with the alginate bandages, bringing distinct advantages for the patients when administered properly.
Kasseroller
Renato G
RG
Klinik St. Barbara, Medizinisches Zentrum Bad Vigaun GmbH & Co. KG, Karl-Rödhammer-Weg 91, 5424 Bad Vigaun, Austria. rgk@drkasseroller.at
Brenner
Erich
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000464:Alginates; D047070:Bandages, Hydrocolloid; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery; D005260:Female; D020723:Glucuronic Acid; D006603:Hexuronic Acids; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000628:therapy*; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000464:Alginates; D006603:Hexuronic Acids; D020723:Glucuronic Acid