Lenfödemde Cilt Bakımı ve Koruyucu Yaklaşımlar Skin Care and Protective Approaches in Lymphedema

Yıl 2016, Cilt: 3 Sayı: 1, 0 - 0, 15.06.2016

Ayşe Arıkan Dönmez Leyla Özdemir

Öz

Lenfödem, yaşamı tehdit eden, bireylerin yaşam biçimlerini ve fonksiyonlarını etkileyen, fiziksel ve psikososyal sorunlara neden olan ve yaşam kalitelerini de olumsuz yönde etkileyen
önemli bir komplikasyondur. Geçmişte tedavisi imkansız olarak düşünülürken, günümüzde lenfödem gelişimini önlemek, semptomlarını kontrol etmek, komplikasyonları azaltmak ve
lenfödem geliştiğinde tedavi etmek amacıyla çeşitli yöntemler önerilmektedir. Bu yöntemler; hasta eğitimi, cilt bakımı, ekstremite elevasyonu, masaj ve fizik tedavi, fiziksel aktivite ve
egzersiz, manuel lenfatik drenaj, self (basit) lenfatik drenaj, pnömatik pompalar, düşük düzeyde lazer tedavisi, kompresyon bandajları ve giysileri, medikal tedavi, cerrahi tedavi olarak
sıralanabilir. Sağlıklı cilt bütünlüğünün korunması ve sürdürülmesi, cildin hidrasyonunun sağlanması, lenfödem gelişiminin önlenmesi, lenfödem komplikasyonlarının tedavi edilmesi, hastanın konforunun/rahatlığının sağlanması ve enfeksiyon riskinin azaltılması açısından cilt bakımı oldukça önemli bir basamaktır. Lenfödemde cilt bakımının rolünü destekleyen bir kanıt bulunmamakla birlikte, lenfödem riskini veya var olan lenfödemin şiddetini azaltmak için cildi korumanın, öz bakımın önemli bir bileşeni olduğu yönünde uzmanlar tarafından belirtilen ortak görüşler bulunmaktadır. Bu nedenle lenfödemi olan veya risk altında olan hastalara, mutlaka uygun cilt bakımı ilkeleri ile ilgili eğitim verilerek, günlük yaşamlarında
bu ilkelere uymaları gerektiği hatırlatılmalıdır.
Anahtar Kelimeler: Cilt bakımı, konservatif tedavi, lenfödem, lenfödem yönetimi

 

Lymphedema is an important life-threatening complication that effects the lifestyle and functions of individuals, causing physical and psychosocial problems and also effects their quality of life negatively. Although its treatment was considered as impossible in the past, today various methods have been suggested in order to prevent lymphedema, controlling the symptoms, reducing complications and treat when it develops. These methods can be aligned as; patient education, skin care, limb elevation, massage and physical therapy, physical
activity and exercise, manual lymphatic drainage, self (simple) lymphatic drainage, pneumatic pumps, low level laser therapy, compression bandages and clothing, medical treatment,
surgical treatment. Skin care is quite important step in terms of protecting and maintaining integrity of healthy skin, providing hydration of the skin, preventing lymphedema, treating complications of lymphedema, providing patient comfort and reducing the risk of infection. Although there is no evidence that supports the role of skin care for lymphedema; there
are common opinions that are being suggested by experts regarding protection of the skinnthat considered to be a critical component of self-care to reduce the risk of lymphedema or
exacerbation of established lymphedema. Therefore, patients with lypmhedema or at risk of developing lymphedema must be educated about proper skin care principles and must be
reminded that their cooperation about these principles is needed.
Key Words: Skin care, conservative treatment, lymphedema, lymphedema management

Kaynakça

• Slavin SA, Schook CC, Greene AK. Lymphedema Management. In: Davis M, Feyer P, Ortner P,
• Zimmermann C, editors. Supportive Oncology. Philadelphia; 2011. p.211-20.
• International Lymphoedema Framework Position Document. Best practice for the management of
• lymphoedema-2nd edition. Compression Therapy: A position document on compression bandaging.
• Dermatological issues in lymphoedema and chronic oedema 2012: 49-56.
• Badger C, Preston N, Seers K, Mortimer P. Physical therapies for reducing and controlling lymphoedema
• of the limbs. Cochrane Database Syst Rev 2004;18:CD003141.
• Szuba A, Achalu R, Rockson SG. Decongestive lymphatic therapy for patients with breast carcinoma
• associated lymphedema. Cancer 2002;95:2260-7.
• Vignes S, Blanchard, M, Arrault, M, Porcher, R. Intensive complete decongestive physiotherapy for
• cancer-related upper-limb lymphedema: 11days achieved greater volume reduction than 4. Gynecologic
• oncology 2013;131(1):127-30.
• Harris SR, Hugi RM, Olivotto IA, Levine M. Clinical practise guidelines for the care and treatment of
• breast cancer. 11. Lymphedema, Canadian Medical Association 2001;164 (2):191-99.
• Bani HA, Fasching PA, Lux MM, Rauh C, Willner M, Eder I, et al. Lymphedema in breast cancer
• survivors: assessment and information provision in a specialized breast unit. Patient Education and
• Counseling 2007;66: 311-18.
• Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a
• three-year follow-up study. QJM: An International Journal of Medicine: Oxford Journals 2005;98:343-
• Park HJ, Lee HW, Chung SH. Incidence and risk factors of breast cancer lymphoedema. Journal of
• Clinical Nursing 2008;17: 1450-59.
• Golshan M, Smith B. Prevention and management of arm lymphedema in the patient with breast
• cancer. J Support Oncol 2006;4(8), 381-6.
• Kebudi A, Uludağ M, Yetkin Ü, Çitgez B, İşgör A. Meme kanseri tedavisinde modifiye radikal
• mastektomi sonrası lenf ödem: İnsidans ve risk faktörleri. Meme Sağlığı Dergisi 2005;1:1-5.
• Morrell RM, Halyard MY, Schild SE, Ali MS, Gunderson LL, Pockaj BA. Breast cancer- related
• lymphedema. Mayo Clinic Proceedings 2005;80:1480-84.
• Wanchai A, Beck M, Stewart BR, Armer JM. Management of lymphedema for cancer patients with
• complex needs. Semin Oncol Nurs 2013 Feb;29(1):61-5.
• International Lymphoedema Framework: An International Perspective. International Consensus Best
• practice for the management of lymphoedema. Skin Care and Cellulitis/Erysipelas 2006: 24-29.
• Lee YM, Mak SS, Tse SM, Chan SJ. Lymphoedema care of breast cancer patients in a breast care clinic: a
• survey of knowledge and health practice. Supportive Care in Cancer 2001;9: 634-41.
• Gary DE. Lymphedema diagnosis and management. Journal of the American Academy of Nurse
• Practitioners 2007;19: 72–8.
• Thomas-MacLean R, Miedema B, Tatemichi SR. Breast cancer-related lymphedema: women’s
• experiences with an underestimated condition. Can Fam Physician 2005; 51:246-47.
• Todd M. Understanding lymphoedema in advanced disease in a palliative care setting. International
• Journal of Palliative Nursing 2009; 15(10): 474-80.
• Zuther JE, Norton S. Lymphedema Management. The comprehensive guide for practitioners. 3rd
• Edition. Stuttgart New York: Thieme; 2013. p.149.
• Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM. Complementary, alternative, and
• other noncomplete decongestive therapy treatment methods in the management of lymphedema: a
• systematic search and review. PM&R 2014;6(3):250-74.
• Sayko O, Pezzin LE, Yen TW, Nattinger AB. Diagnosis and treatment of lymphedema after breast cancer:
• a population-based study. PM&R 2013;5(11):915-23.
• Cheville AL, McGarvey CL, Pertek JA, Russo SA, Taylor ME, Thiadens SR. Lymphedema management.
• Seminar of Radiation Oncology 2003;13:290-301.
• Cancer Australia. Clinical Best Practice/Lymphoedema Specialised treatment 2012. http://
• canceraustralia.gov.au/clinical-best-practice/lymphoedema/gp-guides-and-resources/specialisedtreatment.
• February 2015.
• Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm
• lymphoedema secondary to breast cancer treatment. Annals of Oncology 2007;18(4):639-46.
• Lasinski BB, Thrift KM, Squire D, Austin MK, Smith KM, Wanchai A, et al. A systematic review of the
• evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM&R
• ;4(8):580-601.
• Oremus M, Dayes I, Walker K, Raina P. Systematic review: conservative treatments for secondary
• lymphedema. BMC Cancer 2012;12(1):6.
• Poage E, Singer M, Armer J, Poundall M, Shellabarger MJ. Demystifying Lymphedema: Development
• of the Lymphedema Putting Evidence Into Practice® Card. Clinical Journal of Oncology Nursing
• ;12(6):951-64.
• Bernas MJ, Witte CL, Witte MH. The diagnosis and treatment of peripheral lymphedema: draft revision
• of the 1995 Consensus Document of the International Society of Lymphology Executive Committee
• for discussion at the September 3-7, 2001, XVIII International Congress of Lymphology in Genoa, Italy.
• Lymphology 2001;34(2):84–91
• Szuba A, Rockson SG. Lymphedema: classification, diagnosis and therapy. Vasc Med 1998; 3(2):145–56
• Maclellan RA, Greene AK. Lymphedema. In Seminars In Pediatric Surgery 2014 August;23(4):191-97.
• Asmussen PD, Strössenreuther RHK. Compression Therapy. In: Földi, M. Földi, E. (Ed.) Földi’s Textbook
• of Lymphology for Physicians and Lymphedema Therapists 2 nd edition. Munich, Mosby-Elsevier 2006;
• -627.
• Olszewski WL. Contractility patterns of normal and pathologically changed human lymphatics. Ann N
• Y Acad Sci 2002;979:52–63
• Zuther JE, Norton S. Lymphedema Management. The comprehensive guide for practitioners. 3rd
• Edition. Stuttgart New York: Thieme; 2013. p.326-327.
• Symptom management: evidence summary. Cancer Australia National Cancer Nursing Education
• Project (EdCaN) 2013. URL: http://www.cancerlearning.gov.au/docs/EdCaN-Symptom-managementevidence-
• summary.pdf February, 2015.
• Uzkeser H. Assessment of postmastectomy lymphedema and current treatment approaches. Eur J Gen
• Med 2012; 9(2):130-34.
• Lymphoedema Improving symptom management in cancer care through evidence based practice.
• European Oncology Nursing Society 2012. URL: http://www.cancernurse.eu/documents/
• EONSPEPLymphoedemaEnglish.pdf February, 2015.
• Horning KM, Guhde J. Lymphedema: An under-treated problem. Medsurg Nursing 2007;16(4):221-27.
• Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema:Separating fact from fiction. J
• Am Coll Surg 2011;213(4):543-50.
• Skin care for people with lymphoedema. The Lymphoedema Support Network URL: http://www.nhs.
• uk/ipgmedia/national/Lymphoedema%20Support%20Network/Assets/Skincare%28LSN%29.pdf
• February, 2015.
• Towers A, Hodgson P, Shay C, Keeley V. Care of palliative patients with cancer-related lymphoedema. J
• Lymphoedema 2010; 5:72-80.
• Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast
• cancer survivors: the Iowa women’s health study. Journal of Clinical Oncology. 2008;26(35):5689-96.