Treatment for lymphedema of the arm - The Casley-Smith method - A noninvasive method produces continued reduction

BACKGROUND. This paper gives an outline of the Casley-Smith method for the treatment of lymphedema of the arm. It includes a brief summary of the deve lopment of manual techniques and the terminology applied to them. METHODS. The four principles of this method are skin care, manual lymphatic drainage, compression in the form of bandaging and/or garments, and exerci se. The massage techniques, especially where they differ from other schools , are described in some detail, as are the principles that apply in compres sion and maintenance of reduction in lymphedema. RESULTS, The results of this method have been analyzed both in Australia an d in the United States and are discussed briefly. Mention is made of the be nefits of the benzopyrones, which have been used for many years, when added to the above treatment. Both benzopyrones and exercise will produce a cont inued reduction after the treatment course. They are particularly useful in a less compliant patient. It is stressed that the effect of patient compli ance, particularly after treatment, makes a great difference to the ongoing success of the regime. CONCLUSIONS, A comparison is drawn between the efficacy of various current treatments and their cost. This shows that this combined and conservative m ethod of treatment should be considered before recourse to pumps or surgery . The latter seldom achieve the results of decongestive lymphatic drainage, and, in the long term, they are more expensive. Certain preventive measure s may be indicated following, e.g., mastectomies. Prevention of the onset o f lymphedema is of extreme importance. However, a return to as normal a lif estyle as possible by the patient is also essential. The earlier treatment begins after the onset of lymphedema, the better the prognosis for the pati ent. Lymphedema can and should be treated. Cancer 1998;83:2843-60. (C) 1998 American Cancer Society.