Mastectomy and other operations with removal of regional lymph nodes
Radical mastectomy for breast cancer is complete removal of it with the skin, the pectoralis major muscle fiber from the axillary lymph nodes and infraclavicular regions. This operation causes the woman considerable physical and mental damage.
An immediate complication is swelling of the upper limbs and stiffness of the shoulder joint of the party, often developing in the near future after the operation. Increasing edema of the upper extremity - result lymphostasis it because of the disruption of lymph vessels armpit. Stiffness in the shoulder joint occurs as a result of deformation joint capsule scarring in this area. Have pain when trying to abstraction and a show of hands. Marked limitation of joint movement contribute to increasing stiffness. Patients tend to restrict movement in the joint because of pain, hang on his hand kerchief, which contribute to increasing stiffness. So the best way to combat stiffness and swelling of extremities increase is gymnastics. It should start from the first days after discharge from the hospital, first in special classrooms under the guidance of an instructor and then alone. The patient and her family should understand the importance of physiotherapy and exercise it, guided by specific guidelines.
Instead of resting limb on the operated side required its movement: first, cautious, until the pain and then increasingly larger in amplitude. Rocking motion in the shoulder and elbow joints, lead and lift arms initially produced very patient with his healthy arm, and then independently, without support. We must teach the patient to comb hair patient hand, rubbing the back with a towel, make gymnastic exercises with a stick, etc.
Excision of tissue and lymph nodes areas of regional metastasis is not only in breast cancer. This is a mandatory part of surgical treatment of cancer of many locations. Cellulose and lymph nodes removed during axillary soft tissue tumors of the upper extremity, skin of the back, the chest wall. In these cases, the operation is complicated by swelling of the upper extremity. In cancer of the tongue, lower lip, removed the thyroid gland tissue and submandibular lymph nodes in the areas of triangles of side neck, supraclavicular area, which leads to a temporary mild facial edema. When soft-tissue tumors of the lower limb, external genitalia and anal of the rectum removed tissue and lymph nodes in the groin-thigh region (Dyukena operation), while there is a complication in the form of lower extremity edema.
This swelling of the soil lymphostasis develop shortly after surgery (week, month) and can be treated easily: longitudinal massage, limb elevation. Restoration of lymph flow occurs at the expense of newly formed lymph vessels or the appearance of collateral pathways.
In contrast to the mild edema related directly to surgery, often after 6-12 months. appear later after surgery dense swelling limbs. They are more frequent in patients who underwent combined treatment, when the zone of possible metastases were irradiated before or after surgery. Late thick limb edema may be the result of the process of scarring in these areas, preventing the restoration of lymph drainage routes. But they can be the beginning and the first sign of recurrence. Therefore, each case of delayed edema extremities requires the inspection of the oncologist. If the complaint of the patient on the emergence of late limb swelling should go to an oncologist, regardless of the date of planned examination. If the oncologist will be charged on suspicion of relapse, to initiate measures to eliminate or reduce swelling. They require time and patience to the patient and relatives to fulfill complex assignments oncology massage, self massage, elastic bandaging, therapeutic exercises complex, elevated position on the night and a number of measures to prevent suppuration, erysipelas, the appearance of cracks.