Marcos A L, El Gaaied A B Ammar, Ayed F B, Hassen S B, Zervoudis S, Navrozoglou I, Pechlivani F, Iatrakis G
Oncological Physiotherapist, Tunis.
Clin Exp Obstet Gynecol. 2012;39(4):483-8.
Secondary lymphedema of the upper limb is a complication which can be found in patients who have undergone surgical breast cancer treatment with an axillary dissection. Lymphedema following breast cancer treatment remains a long-term disabling complication which cannot be treated in a decisive and radical manner. The objective of the treatment is to limit complications, to try to preserve the remaining lymphatic system and to develop new anastomosis. It consists of a specific decongestive physiotherapy, which may include a specific lymphatic drainage and skin mobilization, reducing bandages including Mobiderm (Thuasne), and sub-bandage muscular exercises. However variations in the therapy have been recorded by different teams. Our experience in treating lymphedema in Tunisia takes into consideration the epidemiological, climatic, cultural and socio-economic conditions of the country. The difference in our treatment compared to what is being advocated elsewhere essentially consists of the no muscular exercise while wearing a bandage. This is compensated for by daily domestic activities, by prolonging the first two phases of treatment (the intensive phase and the stabilization phase), and by the use of the hydro gel dressing Hydrosob (Hartmann) to prevent blisters induced by the pressure imposed by Mobiderm studs of the bandage on the skin, and also by the superimposition of two types of Mobiderm bandages (small and large blocks).
上肢继发性淋巴水肿是一种并发症，见于接受过腋窝清扫的乳腺癌手术治疗的患者。乳腺癌治疗后的淋巴水肿仍然是一种长期致残性并发症，无法得到决定性的根治性治疗。治疗的目的是限制并发症，试图保留剩余的淋巴系统并建立新的吻合。治疗包括特定的消肿物理治疗，可能包括特定的淋巴引流和皮肤松动，使用包括莫比德姆（Thuasne）在内的减压绷带，以及绷带下的肌肉锻炼。然而，不同团队记录的治疗方法存在差异。我们在突尼斯治疗淋巴水肿的经验考虑了该国的流行病学、气候、文化和社会经济状况。与其他地方所倡导的治疗方法相比，我们治疗方法的不同之处主要在于包扎时不进行肌肉锻炼。这通过日常家务活动、延长治疗的前两个阶段（强化阶段和稳定阶段）、使用水凝胶敷料Hydrosob（Hartmann）防止绷带的莫比德姆纽扣对皮肤施加压力引起水泡，以及叠加两种类型的莫比德姆绷带（小块和大块）来弥补。
