Psychosocial Aspects for Patients and Family Members

*Limb-sparing surgeries may be associated with significant injury to the soft-tissues, compromised lymph-drainage, and lymphedema. The current study summarizes our experience with decongestive-lymphatic-therapy (DLT) in those patients. *Between 1997 and 2001, 26 patients were referred to the DLTservice. There were 15 females and 11 males (age 19–73 years) and diagnosed with 20 soft-tissue and 6 bone tumors. 21 tumors were located in the lower extremities (thighs – 16; legs – 5) and the remaining 5 in the upper extremities (arms – 4; forearms – 2). Nine patients underwent one limb-sparing surgery, 11 patients underwent 2–3 surgeries, and 6 patients underwent more than 4 surgeries. 24 patients were treated with adjuvant radiation therapy. A correlation was noted between the number of surgeries, a proximal anatomic location (thigh/arm), and the magnitude of lymphedema. At the time of referral, all patients had a significant swelling of the operated extremity and associated loss of cosmesis, 21 reported functional limitation, and 2 reported pain. A DLTprotocol consisted of 24 sessions, given over a period of 5 weeks. Each session entailed skin care, manual lymph drainage, bandaging, and active exercises. *Improvements in the volume and cosmesis of the treated extremity were estimated to be good or excellent in 14 patients, moderate in 9 patients, and minimal in 3 patients. 17 of 21 patients with functional limitation and 1 of 2 patients with pain reported significant improvement. Patients who were referred early to DLT typically had a better outcome that was achieved in shorter period. *DLT can improve swelling, loss of cosmesis, functional deficit, and pain associated with limb-sparing surgery. Multiple surgeries, adjuvant radiation therapy and proximal anatomic location are risk factors to the evolution of lymphedema. Recognition of these risk factors and early administration of treatment may achieve even greater improvement in these patients.