Original ArticleNo Access

Prospective Analysis of Simulated Pneumatic Tourniquet Use and Oedema Following Axillary Lymph Node Dissection

Edward J. WU

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

EJW and CHL contributed equally to this work

Search for more papers by this author

Cara H. LAI

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

EJW and CHL contributed equally to this work

Search for more papers by this author

Kunihide MURAOKA

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

Search for more papers by this author

Nicole SEGOVIA

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

Search for more papers by this author

John P. KLEIMEYER

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

Search for more papers by this author

, and

Jeffrey YAO

Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA

E-mail Address: jyao@stanford.edu

Correspondence to: Jeffrey Yao, Professor of Orthopaedic Surgery, Stanford University School of Medicine, Department of Orthopaedic Surgery, 450 Broadway Street, M/C 6342, Redwood City, CA 94063, USA. Tel: +1-650-721-7618, Fax: +1-650-721-3470.

Search for more papers by this author

https://doi.org/10.1142/S242483552450005XCited by:0 (Source: Crossref)

Abstract

Background: Tourniquet use during upper extremity surgery in patients with a history of axillary lymph node dissection (ALND) remains controversial due to the perceived but unproven risk of lymphoedema. We prospectively evaluated upper extremity swelling in patients with a history of unilateral ALND using a standardised tourniquet model.

Methods: A tourniquet was applied to the upper arm bilaterally, with the unaffected side serving as an internal control. Each arm was subsequently held in an elevated position to reduce swelling. Hand volume was measured using an aqueous volumeter.

Results: The patients’ ALND arms experienced slightly greater increases in volume following tourniquet application compared to their healthy control arms. However, this amount of oedema was temporary and reversible, as both arms experienced spontaneous resolution of swelling with no significant difference in residual hand volume at the conclusion of the study.

Conclusions: Tourniquet use may be safe in patients with a history of ALND. Further investigation is needed to verify this in a surgical setting.

Level of Evidence: Level II (Therapeutic)

Keywords:

References

1. Harris SR, Hugi MR, Olivotto IA, Levine M, Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ. January 23, 2001;164(2):191–199. Medline, Google Scholar
2. Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. January 17, 2001;93(2):96–111. https://doi.org/10.1093/jnci/93.2.96. Crossref, Medline, Google Scholar
3. McDuff SGR, Mina AI, Brunelle CL, et al.. Timing of lymphedema after treatment for breast cancer: When are patients most at risk? Int J Radiat Oncol Biol Phys. January 1, 2019;103(1):62–70. https://doi.org/10.1016/j.ijrobp.2018.08.036. Crossref, Medline, Google Scholar
4. Petrek JA, Pressman PI, Smith RA. Lymphedema: Current issues in research and management. CA Cancer J Clin. September–October 2000;50(5):292–307. quiz 308-11. https://doi.org/10.3322/canjclin.50.5.292. Crossref, Medline, Google Scholar
5. Fulford D, Dalal S, Winstanley J, Hayton MJ. Hand surgery after axillary lymph node clearance for breast cancer: Contra-indication to surgery? Ann R Coll Surg Engl. October 2010;92(7):573–576. https://doi.org/10.1308/003588410X12699663904475. Crossref, Medline, Google Scholar
6. Mann T, Hammert WC. Upper extremity surgery after lymph node dissection. J Hand Surg Am. October 2011;36(10):1684–1686. https://doi.org/10.1016/j.jhsa.2011.06.003. Crossref, Medline, Google Scholar
7. Habbu R, Adams JE. Role of elective hand surgery and tourniquet use in patients with prior breast cancer treatment. J Hand Surg Am. September 2011;36(9):1537–1539. quiz 1540. https://doi.org/10.1016/j.jhsa.2011.06.020. Crossref, Medline, Google Scholar
8. Hershko DD, Stahl S. Safety of elective hand surgery following axillary lymph node dissection for breast cancer. Breast J. May–June 2007;13(3):287–290. https://doi.org/10.1111/j.1524-4741.2007.00423.x. Crossref, Medline, Google Scholar
9. Gharbaoui ISND, Thornby J, Kessler FB. Safety of upper extremity surgery after prior treatment for ipsilateral breast cancer: Results of an American society for surgery of the hand membership survey and literature review. J Am Soc Surg Hand. 2005;5(4):232–238. Crossref, Google Scholar
10. Paton M, Kovar A, Iorio ML. An evaluation of safety and patient outcomes for hand surgery following prior breast cancer treatment: Establishing new recommendations in lymphedema. Plast Reconstr Surg. February 2020;145(2):459–467. https://doi.org/10.1097/PRS.0000000000006438. Crossref, Medline, Google Scholar
11. Baker RP, Field J, Gozzard C, Wyatt MC, Robertson Y. Does postoperative hand elevation reduce swelling? A randomized study. J Hand Surg Eur Vol. March 2010;35(3):192–194. https://doi.org/10.1177/1753193408103720. Crossref, Medline, Google Scholar
12. Fagan DJ, Evans A, Ghandour A, Prabhkaran P, Clay NR. A controlled clinical trial of postoperative hand elevation at home following day-case surgery. J Hand Surg Br. October 2004;29(5):458–460. https://doi.org/10.1016/j.jhsb.2004.04.008. Crossref, Medline, Google Scholar
13. Muraoka K, Kleimeyer J, Yao J. Development of a reproducible upper limb swelling model. J Hand Surg Asian Pac Vol. December 2019;24(4):452–455. https://doi.org/10.1142/S2424835519500589. Link, Google Scholar
14. SEER Cancer Stat Facts: Female Breast Cancer. National Cancer Institute. https://seer.cancer.gov/statfacts/html/breast.html (accessed 17 January 2024). Google Scholar
15. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. January 2018;68(1):7–30. https://doi.org/10.3322/caac.21442. Crossref, Medline, Google Scholar
16. Bland KI, Scott-Conner CE, Menck H, Winchester DP. Axillary dissection in breast-conserving surgery for stage I and II breast cancer: A National Cancer Data Base study of patterns of omission and implications for survival. J Am Coll Surg. June 1999;188(6):586–595. discussion 595-6. https://doi.org/10.1016/s1072-7515(99)00056-3. Crossref, Medline, Google Scholar
17. Bozentka DJ, Beredjiklian PK, Chan PSH, Schmidt S, Buzby GP, Bora F. Hand related disorders following axillary dissection for breast cancer. Uni Pa Orthop J. 2001;14:35–37. Google Scholar
18. Ganel A, Engel J, Sela M, Brooks M. Nerve entrapments associated with postmastectomy lymphedema. Cancer. December 1979;44(6):2254–2259. https://doi.org/10.1002/1097-0142(197912)44:6<2254::aid-cncr2820440638>3.0.co;2-9. Crossref, Medline, Google Scholar
19. Baltzer HL, Harvey J, Fox PM, Moran SL. De novo upper extremity lymphedema after elective hand surgery in breast cancer survivors. Ann Plast Surg. July 2017;79(1):24–27. https://doi.org/10.1097/SAP.0000000000000986. Crossref, Medline, Google Scholar
20. Dawson WJ, Elenz DR, Winchester DP, Feldman JL. Elective hand surgery in the breast cancer patient with prior ipsilateral axillary dissection. Ann Surg Oncol. March 1995;2(2):132–137. https://doi.org/10.1007/BF02303628. Crossref, Medline, Google Scholar
21. Gaston RG, Osier L, Lewis D, et al.. Lymphedema following elective hand and wrist surgery in women who are post axillary lymph node dissection: A prospective, cohort study. J Hand Surg. 2016;41(9):S2–S3. Crossref, Google Scholar
22. McLaughlin SA, Wright MJ, Morris KT, et al.. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: Objective measurements. J Clin Oncol. November 10, 2008;26(32):5213–5219. https://doi.org/10.1200/JCO.2008.16.3725. Crossref, Medline, Google Scholar