THE EFFECTS OF MODIFIED COMPLETE DECONGESTIVE THERAPY STATUS POST DESMOID TUMOR SURGICAL EXCISION WITH SUBSEQUENT LEFT UPPER EXTREMITY LYMP

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Introduction. Traditional treatment for Breast Cancer Related Lymphedema involves the use of Complete Decongestive Therapy (CDT) to remove excessive interstitial fluid from the involved limb by utilizing adjacent watershed or drainage regions. However, in this case, after undergoing bilateral mastectomy and reconstruction, the patient later developed an axillary desmoid tumor on the affected side. This required extensive surgical dissection of ipsilateral additional axillary lymph nodes, removal of 75% of the pectoral muscle, removal of multilevel ribs with graft and proximal posterior thorax graft host site. This, along with extensive thixotrophy made traditional lymphatic drainage methods ineffective. An alternative methodology was developed to address her impairments. Case presentation. The subject was a 66 year old women diagnosed with breast cancer in 2006. She underwent chemotherapy in 2007 followed by axillary lymph node removal. She then continued chemotherapy along with radiation therapy. Following 2 weeks of successful treatment for lymphedema, the patients experienced increased pain and increasing edema. She was referred back to her Oncologist who found and the desmoid tumor was surgically excised. In October 2010 she developed additional lymphedema one month after the tumor was removed. She also had impairments in her left UE including pain, loss of range of motion, decreased strength, advanced thixotrophy resulting in limitations in her ability to perform daily living and work activities. Deviation From the Expected. Because drainage through the axillary watersheds was limited, the CDT intervention was modified to use the watersheds in the neck and back. Due to extensive thixotrophy, high pressure manual therapy was used and she wore 4 layers of short stretch with compressive pads under 20-30 mmhg compression sleeves during her home exercise regime. Compression required use of ribbed cotton padding rather than foam due to irritation of skin. Scar mobilization and myofascial release to the pectoral region with chest wall expansion exercises as well as shoulder rotator cuff and scapular strengthening exercises were performed. The patient also joined Crossfit (an elite strength and core condition gym chain)and aggressively continued with a home exercise regime while wearing her compression garment. Discussion. The modification of traditional CDT with the addition of an intense exercise regime was successful in decreasing edema and pain while increasing strength and range of motion. Addressing the orthopedic and soft tissue deficits along with the edema was imperative for the long term success of this patient outcome. Conclusion. The aggressive exercise regime did not exacerbate the edema but effectively assisted in the tissue mobility and function of the arm. The limitation of Medicare's benefit to 2 weeks or 10 days for CDT forced the patient into self pay for continues CDT but did cover the therapy intervention for the other impairments. Grants. None