Catherine Hunt and Roshanak Kamyab. Journal of Lymphoedema, 2018, Vol 13, No 1

Main findings

• Pre-surgical clinical assessment revealed AWS restricting right shoulder abduction, flexion and elbow extension.
• Post-surgery, the axillary webbing appeared visibly unchanged.
• Lymphatic vessel trauma during surgical dissection, or cellular destruction due to chemotherapy could release inflammatory and thrombotic mediators, such as thrombokinase, precipitating lymph fluid coagulation and peri-lymphatic inflammation and adhesions.
• It is helpful to understand if the tissue restriction involves neural, vascular or fascial components as their sensitivity.
• It is possible that tumour invasion caused preliminary disruption of the axillary lymph node structure and function.
• Chemotherapy impacted the cancerous nodal tissue, mediating local lymphatic vessel inflammation, phlebitis, adhesions and lymph flow stasis with symptomatic AWS. The scarring of the lymph nodes that the surgeon observed intraoperatively also gradually tensioned the surrounding fascial structures adding the thicker band of axillary tissue observed.