Prophylactic compression garments following lymph node dissection during air travel
Dear OncoLink "Ask The Experts,"
I had a mastectomy and lymph nodes removed in August 2001 because I had Paget's Disease. I am planning a trip and a friend told me I need to wear some sort of a arm bandage on my arm to prevent swelling in the arm where the nodes were removed. Is this true and where do I need to go to get the bandage? Should I contact my oncologist regarding this issue?
Andrea Cheville, MD, Director of the Abramson Cancer Center of the University of Pennsylvania's Cancer Rehabilitation Program responds.
There has been a longstanding controversy regarding the use of prophylactic compression garments following lymph node dissection during air travel. The Casley-Smiths reported that 6% of lymphedema patients initially develop swelling during or following air travel. This has supported the practice of wearing compression class I garments on limbs at risk during extended airplane flights.
The physiological rational for this practice is the increased movement of fluid across blood capillary walls when tissue pressure decreases. Pressure exerted by the body's tissues opposes the leakage of fluid from blood vessels. This pressure is important in maintaining a balance between the leakage and removal of fluid. If too much leakage occurs, chronic swelling can develop. When we are aloft in an airplane the cabin is pressurized. Cabin pressures are significantly lower than the atmospheric pressures we normally experience. When atmospheric pressure drops, so does our tissue pressure. They are directly related. As tissue pressure is reduced, there is greater movement of fluid from blood vessels into tissue. Consequently, fluid may build up to the point that it exceeds the transport capacity of the lymphatic system. Most people develop some degree of swelling if they fly for a long enough period. For example, we generally have difficulty donning our shoes once we've landed on the other side of the Atlantic. Our feet have swollen. People with compromised lymphatic systems will have greater difficulty removing the extra fluid and remain swollen for longer periods of time. If they fail to receive appropriate treatment, they may remain permanently swollen. Only the territory drained by the resected or irradiated lymph nodes is at risk. For example, a woman who has undergone dissection of the lymph node in her armpit will only be at risk for swelling in her breast, arm, and upper trunk (on the side of the surgery). The rest of her lymphatic system is intact and should be able to adequately drain fluid from all other body parts.
There is some concern that wearing sleeves may interfere with the function of a lymphatic system that has been injured but is adequately handling the fluid load. In certain patients a few lymph vessels may be sufficient to drain the lymph produced in an arm or leg. Some patients actually swell when they don a compression garment. It seems that the added compression interferes with the transport capacity of the lymphatics and tips the system into overload. For this reason, patients who do not have lymphedema but wish to wear a sleeve should only use compression class I garments. Stronger compression will do more harm than good.
The current recommendation of the Lymphedema Service at the Abramson Cancer Center of the University of Pennsylvania for patients who are at risk but have NO history of swelling is to wear a Compression Class I sleeve during flights greater than 3 hours. All patients who have had an isolated episode of swelling should wear a sleeve regardless of the length of the flight. All patients with chronic lymphedema should wear a sleeve or apply compressive bandaging during ALL air travel. The sleeve should be donned before the airplane cabin is pressurized. This can be done at the airport gate or on the plane prior to take off. The sleeve or stocking should be worn for a brief period, 1-2 hours, after landing. A trained professional must fit compression sleeves. Your hospital may have a physical or occupational therapist capable of fitting compression garments. Alternatively, many surgical supply or durable medical equipment providers employ trained fitters. It is important that you contact your insurance company first since they may have contracted with a particular provider.