Hot of the Press December 2025

Article to ponder

This article offers a comprehensive review of lymphedema, covering its causes, mechanisms, diagnosis, and treatment. It explains genetic and acquired origins, highlights how lymphatic stasis drives inflammation and fibrosis, and reviews advanced imaging for early detection. The paper also outlines standard therapies, surgical innovations, and emerging immune-targeted drugs, emphasizing personalized, integrated care strategies.

Advances in etiology, pathophysiology, diagnosis, and management of lymphedema: a comprehensive review

Tianqi Wu, Jun Pu, Qi Yao, Siying Chen, Youheng Yao, Suyan Chang, Riyun Yang, Jianhong Shen. Front Med (Lausanne). 2025 Nov 6

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Key Takeaway: Early detection and integrated treatment strategies—combining advanced imaging, conservative care, microsurgery, and emerging immune-targeted therapies are essential to prevent irreversible tissue changes and improve outcomes for patients with lymphedema.

We have collated some great articles and material published over the last month. Click on the links below to read the  abstract or download the full paper.

Anatomy / Physiology /Pathophysiology

Anatomy, pathophysiology and assessment of upper-body lymphoedema

Sandi Davis, Suzie Ehmann, Brandy McKeown, Neil B. Piller, Joseph Dayan, Hiroo Suami, Justine C. Whitaker, Karen Bock. J Wound Care. 2025 Nov 11.

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Prevalence and Risk Factors

Predictors of early arm lymphoedema in breast cancer patients treated with modified radical mastectomy -a prospective observational study

Mohd Ozair Khan, Farhanul Huda, Shalinee Rao, Vidhu Shekhar Khare, Kanmathareddy Amulya, Nirmal Raj, Adarsh Jha, Aditya Arnav, Somprakas Basu. BMC Surg. 2025 Nov 5.

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The Association of Hand Dominance With the Development of Breast Cancer-related Lymphedema After Mastectomy: A Retrospective Analysis

Devin J. Clegg, Payton Grande, Jeein Yoon, Gulsah Onar, Jeremy Watts, Anahita Khojandi, Vasileios Maroulas, Stefanos Boukovalas. Plast Reconstr Surg Glob Open. 2025 Nov 10. Nov

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Assessment

Redefining the Diagnostic Threshold for Breast Cancer-related Lymphedema

Benjamin D. Wagner, Andrea V. Barrio, Michelle R. Coriddi, Jonathan Rubin, Lillian A. Boe, Ronnie L. Shammas, Jacob Levy, Geoffrey E. Hespe, Hidehiko Yoshimatsu, Stanley G. Rockson, Babak J. Mehrara. Ann Surg. 2025 Nov 12.

OBJECTIVE: To empirically determine a normative, distribution-based threshold for diagnosing breast cancer-related lymphedema (BCRL) and compare its diagnostic accuracy with the conventional 10% interlimb volume difference criterion.

SUMMARY BACKGROUND DATA: BCRL is a common and morbid sequela of breast cancer treatment; however, diagnostic thresholds remain inconsistent and inadequately validated. The widely used threshold of ≥10% interlimb volume difference may miss clinically relevant cases.

METHODS: This prospective cohort study analyzed preoperative bilateral limb measurements in 858 female breast cancer patients undergoing axillary surgery to derive a normative, distribution-based interlimb volume difference threshold. A threshold corresponding to 2 standard deviations (SD) above the mean (7.5%) was identified. Diagnostic performance of this proposed threshold was then compared with the conventional 10% cutoff in a subgroup of 167 patients who underwent axillary lymph node dissection (ALND) with up to 36 months of postoperative follow-up.

RESULTS: Among 858 patients (median [IQR] age, 48 [40-56] years; median BMI, 25.5 [22.3-30.0] kg/m²), preoperative interlimb volume differences were normally distributed (mean, 0.24%; SD, 3.74%), supporting a proposed diagnostic threshold of 7.5%. In the 167 patients who underwent ALND, 72 (43.1%) met the ≥7.5% threshold versus 53 (31.7%) meeting the 10% threshold, yielding 19 additional diagnoses (+11.4%; P<..001). Of those meeting the 7.5% threshold, 94.4% (68/72) reported symptoms and/or used compression garments. CONCLUSIONS: A normative, distribution-based threshold of 7.5% interlimb volume difference improves the identification of clinically meaningful BCRL compared with the traditional 10% cutoff. Adopting this empirically validated threshold may enhance early detection, intervention, and patient outcomes.:10.1097

Body image and related factors in patients with lower extremity lymphedema and lipedema: a cross-sectional study

Sedef Ersoy, Fatma Nur Kesiktaş, Büşra Şirin Ahısha, Cansın Medin Ceylan, Nurdan Paker, Derya Buğdaycı. Rev Assoc Med Bras (1992). 2025 Oct 27. 

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Lymphedema Imaging and AI: A Review of Diagnostic Modalities, Biomarkers, and Clinical Integration

Bushra Urooj, Sabir Ali, Syed Kumail Hussain Naqvi, Furen Xiao, Po-Cheng Huang. Biomed J. 2025 Nov 19

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Management Strategies

Technology-enhanced compression and AI-integrated lymphedema care: a narrative review

Amany Gomaa Atiaa, Mostafa M. Mostafa, Doha El-Sayed Ellakwa. Ir J Med Sci. 2025 Nov 3.

BACKGROUND: Lymphedema is a persistent and often debilitating condition resulting from lymphatic system dysfunction. It frequently develops as a secondary complication, especially after cancer treatments. Traditional management, centered on complete decongestive therapy (CDT), offers modest benefits but is limited by accessibility, long-term adherence, and variable patient response.
AIMS: This narrative review explores how digital health and enhanced compression technologies are reshaping lymphedema care.
METHODS: A comprehensive review of pertinent literature was conducted to assess the utilization of artificial intelligence (AI), telehealth platforms, mobile applications, virtual reality-based rehabilitation, and advanced compression devices in the management of lymphedema. Focus was directed towards their clinical efficacy, patient-centered advantages, and the challenges associated with their implementation.
RESULTS: AI-driven instruments exhibit significant promise for precise risk stratification, prompt diagnosis, and individualized treatment planning. Digital platforms-including telehealth services, mobile applications, and virtual rehabilitation programs-improve accessibility, enhance patient engagement, and promote sustained adherence over time. Cutting-edge compression modalities, such as sensor-equipped garments, adaptive pneumatic systems, and vibration-assisted apparatus, deliver dynamic, feedback-informed therapeutic interventions. The amalgamation of these technological advancements with wearable biosensors and AI-powered platforms has yielded promising outcomes in limb volume regulation, rehabilitation efficacy, and overall quality of life. Nevertheless, challenges persist concerning equitable access, compliance with regulatory frameworks, cost-effectiveness, and the preparedness of clinicians.
CONCLUSION: Digital health and sophisticated compression methodologies signify a transformative advancement in lymphedema management, promoting anticipatory, individualized, and universally accessible healthcare. Mitigating existing obstacles is crucial for the effective incorporation of these approaches into standard clinical protocols.:10.1007

Categorising compression garments and accessories for upper-body lymphoedema

Brandy McKeown, Suzie Ehmann, Sandi Davis, Karen Bock, Naomi D. Dolgoy. J Wound Care. 2025 Nov 11.

Compression therapy is pivotal to the management of lymphoedema of the upper limb, breast and trunk. Compression can be achieved with a range of garment types and accessories. Distinguishing between these categories is foundational to using the STRIDE algorithm for compression selection, a tool designed to guide healthcare providers in optimising compression therapy for improved patient outcomes. This article outlines the seven garment categories of circular-knit garments, stiffer circular-knit garments, flat-knit garments, adjustable wraps, decongestive wraps, night-time garments and trunk garments, as well as two compression accessories: focal pads and donning/doffing aides. It also discusses how garments within these categories can be distinguished by textile properties, such as pressure, stiffness and containment.:10.12968.34.S11c.S30

Key Points: Categorising Compression Garments for Upper-Body Lymphoedema

A new update to the STRIDE framework expands guidance on compression garment selection to include the upper limb, breast and trunk—areas where research and clear prescribing guidelines have been limited.

1. Seven Garment Categories Identified
The article outlines seven main garment types used in upper-body lymphoedema management:

  • Circular-knit garments – soft, thin, lower-stiffness options suited to mild oedema.

  • Stiffer circular-knit garments – provide greater containment and moderate–high pressure.

  • Flat-knit garments – highly customisable, stiffer and more containing; ideal for moderate–severe or irregular limb shapes.

  • Adjustable wraps – modifiable compression suitable for rapid volume change or self-management.

  • Decongestive wraps – designed for the intensive reduction phase as an alternative to multi-layer bandaging.

  • Night-time garments – low-pressure options that support self-management, comfort and prevention of rebound swelling.

  • Trunk garments – bras, vests and shirts that support breast and chest-wall oedema.

2. Two Accessory Categories

  • Focal pads – used to provide targeted pressure over fibrosis, asymmetry or skin folds.

  • Donning/doffing aids – help improve ease of application and adherence.

3. Importance of Textile Properties
Garments vary widely in pressure, stiffness, containment, elasticity and fatigue. Understanding these properties is essential for selecting the correct device based on:

  • Stage of treatment (reduction vs maintenance)

  • Tissue texture

  • Anatomical shape

  • Patient comfort, function and preferences

4. Patient-Centred, Individualised Selection
No single garment type is superior for all presentations. Optimal outcomes rely on matching garment characteristics to clinical needs while considering comfort, cosmesis, cost and functional ability.

5. Benefits of the Updated STRIDE Framework
The expanded classification:

  • Supports clinicians in more consistent and informed decision-making

  • Helps manufacturers clearly define and communicate product features

  • Improves patient understanding and confidence in garment selection

  • Encourages innovation and standardisation across the industry

The science of compression textiles and garments for upper-body lymphoedema

Suzie Ehmann, Brandy McKeown, Sandi Davis, Karen Bock. J Wound Care. 2025 Nov 11.S11c).

Compression therapy is a cornerstone in the management of upper-body lymphoedema. Compression helps reduce oedema, restore function and improve tissue integrity, contributing to enhanced quality of life and more efficient use of healthcare resources. To achieve this, compression garments must be appropriately designed, selected and applied to meet diverse patient needs. Therapeutic effect is determined by the garment’s textile properties, including resting pressure, stiffness and gradient, as well as containment, fatigue and moisture wicking. This article synthesises the evidence for how these properties impact management of lymphoedema in the upper limb, breast and trunk, as well as making recommendations for future research and innovation.:10.12968.34.S11c.S.

Key Points for Clinical Practice

  1. Compression Therapy as Cornerstone
    • Essential for managing upper-body lymphoedema (arm, breast, trunk).
    • Benefits include oedema reduction, improved tissue integrity, symptom relief, and enhanced quality of life.
  2. Early Intervention Matters
    • Applying compression early (even in stage 0) can improve microvascular flow and prevent progression of lymphoedema.
  3. Textile Properties Drive Therapeutic Effect
    • Critical factors:
      • Interface Pressure (Dosage): Optimal range for upper body often 15–32 mmHg; higher pressures do not always improve outcomes and may reduce adherence.
      • Stiffness: Higher stiffness boosts working pressure during activity without increasing resting pressure, aiding lymphatic stimulation.
      • Containment: Prevents tissue distortion and supports oedema control.
      • Moisture Wicking: Vital for skin integrity, especially in axilla and trunk regions.
  4. Pressure Distribution & Gradient
    • Graduated pressure (higher distally, lower proximally) promotes lymphatic drainage.
    • Poorly designed garments can create harmful focal pressure zones—individualised selection is essential.
  5. Patient Comfort & Adherence
    • Comfort strongly influences compliance; lower-to-moderate pressures often achieve good outcomes with better tolerance.
    • Garment fatigue occurs over time—replace every 4–6 months and provide at least three garments per site for rotation.
  6. Evidence Gaps & Research Needs
    • Limited data for upper-body compression compared to lower limb.
    • Need for standardised protocols for measuring interface pressure, stiffness, and pressure gradients.
    • More studies on clinical outcomes beyond volume reduction (e.g., QoL, functional performance).
  7. Future Directions
    • Smart textiles with sensors for real-time pressure monitoring.
    • Custom 3D-printed garments for anatomical precision.
    • Eco-friendly materials and cost-effective solutions to reduce financial burden.

Using the STRIDE algorithm for compression selection in upper-body lymphoedema

Suzie Ehmann, Brandy McKeown, Sandi Davis, Karen Bock, Justine C. Whitaker, Naomi D. Dolgoy. J Wound Care. 2025 Nov 11.S11c).

This second iteration of STRIDE is an evidence-based algorithm for compression selection, extended to cover the upper limb, trunk and breast. The STRIDE algorithm is patient-centred and complexity-informed, encompassing the site, shape and size of oedematous swelling; impact of tissue texture on textile types; 24-hour refill patterns; patient-specific issues; pressure dosage among other textile characteristics; and oedema etiology and staging. This article details the elements of the STRIDE algorithm and presents practical tools for its application.:10.12968.34.S11c.S36.

Key Points for Clinical Practice

  1. STRIDE Algorithm Overview
    • A structured, evidence-based framework for individualised compression selection in upper-body lymphoedema (arm, breast, trunk).
    • Moves beyond dosage-only approaches by integrating six factors:
      Shape, Texture, Refill, Issues, Dosage, Etiology.
  2. Shape & Size
    • Assess site-specific swelling (hand, arm, breast, trunk) and limb contours.
    • Complex shapes or pronounced contours often require custom garments or focal pads for even pressure distribution.
  3. Texture Matters
    • Tissue types (watery, doughy, woody, fatty, fragile) guide textile choice:
      • Watery: elastic or medium stiffness
      • Doughy/Woody: stiff and textured
      • Fatty: stiff, textured, layered
      • Fragile: gentle textiles, underliners, donning aids
    • Textured textiles (LAPPs) help soften fibrosis and stimulate lymphatic flow.
  4. Refill Patterns
    • Speed of oedema return after garment removal determines wear schedule:
      • Rapid refill: day & night compression
      • Slow refill: daytime only
    • Night-time garments are essential for persistent or fibrotic cases.
  5. Patient Issues & Practicality
    • Consider functional ability, cosmesis, temperature control, psychological wellbeing, and financial constraints.
    • Use donning/doffing aids and breathable fabrics to improve adherence.
  6. Dosage & Stiffness
    • Typical ranges:
      • Mild: 15–21 mmHg
      • Moderate: 23–32 mmHg
      • Severe: 34–46 mmHg
    • Stiffer textiles can achieve therapeutic effect at lower pressures, improving comfort.
  7. Etiology-Informed Selection
    • Cancer-related, neurological, or trauma-induced lymphoedema may require tailored strategies (e.g., directional compression, adjustable wraps).
  8. Clinical Tools Provided
    • STRIDE checklist, garment characteristic chart, and algorithm flowchart for practical application.
    • Supports standardised documentation and insurance advocacy.
  9. Future Directions
    • Integration with imaging and microcirculation science.
    • Industry adoption for training and product transparency.
    • Research into cost-effectiveness and patient-centred outcomes.

Effectiveness of contrast compression therapy for post-stroke complex regional pain syndrome: a randomized control trial

Meltem Güneş Akıncı, Cemile Sevgi Polat, Ayşegül Tombak Demirçakan, Yusuf Ziya Bükün, Meltem Dalyan. Top Stroke Rehabil. 2025 Nov 19.-10.

BACKGROUND: Complex regional pain syndrome (CRPS) is a frequent complication after stroke that negatively impacts pain, function, and rehabilitation outcomes.
OBJECTIVE: This study aimed to assess the effectiveness of additional contrast compression therapy combined with conventional rehabilitation on edema, pain, function, motor recovery, and spasticity in post-stroke CRPS.
METHODS: This prospective, assessor-blind randomized controlled trial was conducted at the inpatient stroke rehabilitation clinic. Seventy-two patients with upper extremity CRPS type-I in the subacute stage after a first-ever stroke were randomly assigned to an experimental or control group. Both groups underwent a standardized conventional rehabilitation program 5-day/week, 3-hours/day for 4 weeks, including positioning, range of motion, stretching, strengthening, and transcutaneous electrical nerve stimulation. The experimental group additionally received contrast compression therapy once daily 15-minutes/session for 10 days. Outcomes were edema (water displacement), rest and activity-related pain (Visual Analog Scale), neuropathic pain (painDETECT Questionnaire), functional status (Functional Independence Measure-Motor), motor recovery (Brunnstrom Stages), and spasticity (Modified Ashworth Scale) assessed at baseline and post-treatment 4 weeks.
RESULTS: Both groups showed significant improvements in all outcomes (p < .05). The experimental group demonstrated significantly greater reductions in edema volume and activity-related pain than the control group (p < .001 and p = .001, respectively). No between-group differences were observed in neuropathic pain, functional status, motor recovery, and spasticity.
CONCLUSIONS: Contrast compression therapy provided superior short-term benefits for reducing upper extremity edema and activity-related pain when added to conventional rehabilitation in post-stroke CRPS. It may serve as an effective non-pharmacologic adjunct in stroke rehabilitation.Clinical Trial Registration: NCT07062913.:10.1080/10749357.2025.2589193

Key Points from the Article

  • Study Purpose: To evaluate the effectiveness of contrast compression therapy (CCT) combined with conventional rehabilitation for post-stroke complex regional pain syndrome (CRPS).
  • Design: Assessor-blind randomized controlled trial with 72 patients having upper extremity CRPS-I after stroke.
  • Intervention: Both groups received standard rehabilitation (ROM, stretching, strengthening, TENS). The experimental group additionally received CCT for 10 sessions (15 min/day).
  • CCT Protocol: Alternating thermal phases (3 min at 40°C hot, 1 min at 4°C cold) combined with intermittent pneumatic compression (5–30 mmHg) using a Game Ready system.
  • Outcomes Measured: Oedema (water displacement), pain (VAS), neuropathic pain (painDETECT), functional status (FIM-motor), motor recovery (Brunnstrom stages), spasticity (Modified Ashworth Scale).
  • Results: Both groups improved significantly, but CCT group had greater reduction in oedema and activity-related pain (p < .001). No significant differences in neuropathic pain, motor recovery, or spasticity.
  • Conclusion: CCT is a safe, non-pharmacologic adjunct that enhances short-term control of oedema and pain in post-stroke CRPS.

Current status and influence of positive aspects of caregiving among family caregivers of patients with breast cancer-related lymphedema: a cross-sectional study

YiDan Tang, Qingfeng Wei, Menghua Yu, Longshuang Zhu. Support Care Cancer. 2025 Nov 19.

PURPOSE: This study aimed to investigate the current status of positive aspects of caregiving among family caregivers of patients with breast cancer-related lymphedema and to analyze its influencing factors.
METHODS: The study included 228 pairs of lymphedema patients and their primary family caregivers. The researchers used the General Information Questionnaire, the Positive Aspects of Caregiving Scale, the Caregiver Burden Scale for Cancer Patients, the Self-Efficacy Questionnaire for Chinese Family Caregivers, and the Connor-Davidson Resilience Scale to collect data. Univariate analysis and multiple linear regression were performed to identify factors associated with the positive aspects of caregiving.
RESULTS: The results showed that the score for positive aspects of caregiving among family caregivers of patients with breast cancer-related lymphedema was 32.20 ± 2.65. Multiple linear regression analysis identified the following factors as significant influencers of positive aspects of caregiving: the degree of lymphedema in the patient, caregiver literacy, average monthly income of the person, knowledge of the disease, caregiver burden, self-efficacy, and resilience (all P < 0.05).
CONCLUSIONS: Family caregivers of breast cancer-related lymphedema patients reported a moderate level of positive caregiving experiences, and healthcare professionals need to pay attention to caregivers’ positive experiences and provide targeted guidance based on the influencing factors to improve their positive experiences and the overall quality of life of the family.:10.1007

Effects of 4-Week Complex Decongestive Therapy in the Management of Breast Cancer-Related Arm Lymphedema in Montenegrin Women Post-Mastectomy and Chemo/Radiotherapy

Miloš Kuzmanović, Dušan Mustur. Healthcare (Basel). 2025 Oct 15..3390/healthcar

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The treatment efficacy of complete decongestive therapy for breast cancer-related lymphedema from the perspective of skin mechanical properties: a case study

Yudai Fujimoto, Yoshimi Yuri, Miki Fujii, Saki Matsui, Hironari Tamiya. J Phys Ther Sci. 2025 Nov 37.-583. Epub 2025 Nov 1. 

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Non-pneumatic Compression and Its Clinical Utility in Management of Lymphedema. A position statement endorsed by the American Venous Forum and the American Venous and Lymphatic Society

Glenn R. Jacobowitz, Ruth Bush, Ronald S. Winokur, Joseph D. Raffetto. J Vasc Surg Venous Lymphat Disord. 2025 Nov 19

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Intermittent pneumatic compression devices for the prevention and treatment of breast cancer-related lymphedema-a systematic review and meta-analysis

Liyao Su, Haihong Huang, Yang Tong, Lu Dong, Chenxuan Gu, Siqi Zhuang, Shuyao Bai, Yongmei Jin. Support Care Cancer. 2025 Nov 22

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