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Lymphedema Following Elective Hand and Wrist Surgery in Women who are Post Axillary Lymph Node Dissection: A Prospective, Cohort Study
John W. Bracey, MD1; Mark Tait, MD1; Glenn Gaston, MD1; Lois Kathleen Osier, MD1; Susan M. Odum, PhD2; Bryan Loeffler, MD1; Robert Chadderdon, MD1; William Alan Ward, MD1
1OrthoCarolina Hand Center, Charlotte, NC; 2OrthoCarolina Research Institute, Charlotte, NC

Introduction: We sought to evaluate the rate of lymphedema and perioperative complications in patients with a history of breast cancer and ipsilateral lymph node dissection undergoing elective upper extremity surgery with and without a brachial tourniquet.

Methods: A prospective, multi-center study was undertaken and included procedures ranging from trigger finger release to metastatic cancer excision from the brachial plexus. Validated volumetric measurements of the limb were obtained pre- and post- operatively and all complications were recorded. 44 patients (mean age 61 years) completed follow up, included 24 operatively treated with a tourniquet and 20 without. Median time from mastectomy for patients without tourniquet was 10.8 years [IQR 2.2-18.5], compared to 8.0 years [IQR 3.7-15.7 years] (p=0.94). Standard descriptive statistics were calculated. Groups were compared using Fishers Exact and Wilcoxon tests.

Results: There were no cases of lymphedema at 3 month and 6 month follow up. One patient, in the no tourniquet group, had lymphedema at the 2 week follow up visit only. No complications were noted in any patient. Procedures using a tourniquet were on average twice as long as those that were not, yet no difference in the incidence of lymphedema or complications was noted.

Discussion: Elective upper extremity surgery appears safe in patients having undergone previous ipsilateral surgery for breast cancer with lymph node dissection including those with previous radiation and history of lymphedema. The use of a tourniquet does not appear to increase the risks of lymphedema or complications in this patient population.

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