title: Biomechanical Properties of the Skin in Patients with Breast Cancer-Related Lymphedema Compared to Healthy Individuals.
abstract: BACKGROUND
  Biomechanical skin changes in breast cancer-related lymphedema (BRCL) have barely been described and objectively tested. This study aims to compare the skin of upper limb lymphedema with skin of the healthy contralateral arm, in order to demonstrate changes of elasticity, viscoelasticity, and level of hydration of the skin in BCRL. The secondary aim is to investigate the correlation between biomechanical skin changes and measurements that are currently used in clinical practice, such as volume measurement and lymph-ICF score.
  
  
  RESULTS
  Eighteen patients with BCRL and 18 healthy individuals were included in the study. A Cutometer® was used for measurements for skin elasticity and viscoelasticity on both arms of each subject. A Corneometer® was used for measurements of skin hydration. Measurements of both test groups were compared. In BCRL patients, there was a significant difference (p = < 0.028) between the elasticity of the skin of the lymphedema arm compared to the healthy contralateral arm. There were no significant differences for level of skin hydration or viscoelasticity in lymphedema patients between the measurements on the skin of the lymphedematous and healthy arm. In healthy individuals, there were no significant differences for all measurements between skin of both arms. Spearman's correlation was significant (p = < 0.01) for difference in volume and difference in elasticity in BCRL patients.
  
  
  CONCLUSIONS
  This study shows an impaired elasticity for the skin of the lower arm in patients with lymphedema compared to the contralateral healthy arm. Promising evidence is suggested for the use of the Cutometer device in the diagnostic evaluation of BCRL.
authors: 1 Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .
authors: R C
authors: RC
authors: Killaars
authors: 1 Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .|2 Department of General Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .
authors: T R Lopez
authors: TR
authors: Penha
authors: 2 Department of General Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .
authors: E M
authors: EM
authors: Heuts
authors: 1 Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .
authors: R R J W
authors: RR
authors: van der Hulst
authors: 1 Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+) , Maastricht, The Netherlands .
authors: A A
authors: AA
authors: Piatkowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000473:pathology; D001696:Biomechanical Phenomena; D001943:Breast Neoplasms / Q000150:complications*; D016022:Case-Control Studies; D002648:Child; D004548:Elasticity; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis* / Q000209:etiology*; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*; D055815:Young Adult