<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02977182</url>
  </required_header>
  <id_info>
    <org_study_id>9521</org_study_id>
    <nct_id>NCT02977182</nct_id>
  </id_info>
  <brief_title>Lymphedema Treatment for Blunt Facial Trauma</brief_title>
  <official_title>The Effect of Lymphedema Treatment for the Management of Blunt Facial Trauma</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Our Lady of the Lake Regional Medical Center</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Our Lady of the Lake Regional Medical Center</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      Injuries to the face caused by traumatic events such as motor vehicle collisions, assault,&#xD;
      and falls can result in facial trauma, which can result in swelling and disfiguration that&#xD;
      impairs the important functions of the face, sometimes to a life threatening degree. These&#xD;
      injures and the resultant swelling can also precipitate psychological and social&#xD;
      consequences.&#xD;
&#xD;
      Lymphedema is an abnormal amount of fluid that causes swelling, usually in the arms or legs.&#xD;
      The most common presentation of lymphedema is in the upper extremities due to breast cancer&#xD;
      treatment (Maclellean RA et al). As such, standards of care for management of lymphedema are&#xD;
      primarily derived from the cancer research literature and involve the extremities (Moffatt&#xD;
      CJ. 2003 QJM). The current gold standard treatment for patients with extremity lymphedema is&#xD;
      complete decongestive therapy (CDT) (Zuther 2013). CDT is a multimodal therapy consisting of&#xD;
      four components: manual lymph drainage, compression wrapping, exercise, and skin care (Zuther&#xD;
      2013).These same therapeutic techniques of CDT have been employed at Our Lady of the Lake&#xD;
      Regional Medical Center (OLOLRMC) and adapted to treat patients with facial trauma with&#xD;
      anecdotally good results primarily related to cosmesis. To the best of our knowledge, no&#xD;
      clinical studies examining the effect of lymphedema treatment in the management of blunt&#xD;
      facial trauma currently exist.. Beyond the consideration of cosmesis, we also seek to&#xD;
      determine if this intervention improves clinical outcomes such as time to swallowing and&#xD;
      reduced time utilizing mechanical ventilation. This study will prospectively evaluate the use&#xD;
      of complete decongestive therapy to test the hypothesis that this intervention results in&#xD;
      improved clinical outcomes in patients with blunt facial trauma.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Introduction The face is an anatomically complex structure, consisting of skin, muscles for&#xD;
      both fine and gross motor functions, a complex bony structure, and vital sensory organs.&#xD;
      These structures allow one to eat, breathe, see, hear, and speak. Injuries to the face caused&#xD;
      by traumatic events such as motor vehicle collisions, assault, and falls can result in facial&#xD;
      trauma, which can result in swelling and disfiguration that impairs the important functions&#xD;
      of the face, sometimes to a life threatening degree. These injures and the resultant swelling&#xD;
      can also precipitate psychological and social consequences.1-3 Lymphedema is an abnormal&#xD;
      amount of fluid that causes swelling, usually in the arms or legs. Though lymphedema can&#xD;
      occur as a result of trauma, it is most commonly associated with side effects of certain&#xD;
      cancer-related treatments such as radiation therapy and lymph node removal. The most common&#xD;
      presentation of lymphedema is in the upper extremities due to breast cancer treatment.4 As&#xD;
      such, standards of care for management of lymphedema are primarily derived from the cancer&#xD;
      research literature and involve the extremities.5 The current gold standard treatment for&#xD;
      patients with extremity lymphedema is complete decongestive therapy (CDT).6 CDT is a&#xD;
      multimodal therapy consisting of four components: manual lymph drainage, compression&#xD;
      wrapping, exercise, and skin care.6 Manual lymph drainage (MLD) is a delicate form of massage&#xD;
      designed to improve tissue and cellular health by facilitating fluid removal from edematous&#xD;
      areas. Compression wrapping utilizes compression garments or short stretch compression&#xD;
      bandages and is primarily used in the acute (or intensive) phase of CDT as a means to&#xD;
      reinstate sufficient resistance to skin tissues whose elastic fibers are damaged by&#xD;
      lymphedema. Exercise, especially when combined with compression, improves removal of fluid&#xD;
      from the affected area. Finally, skin care treatments keep skin clean and moisturized to&#xD;
      reduce infections that can occur with lymphedema.6 These same therapeutic techniques of CDT&#xD;
      have been employed at Our Lady of the Lake Regional Medical Center (OLOLRMC) and adapted to&#xD;
      treat facial edema in patients with facial trauma with anecdotally good results in terms of&#xD;
      cosmesis. To the best of our knowledge, no clinical studies examining the effect of&#xD;
      lymphedema treatment in the management of blunt facial trauma currently exist. Beyond the&#xD;
      consideration of cosmesis, we also seek to determine if this intervention improves clinical&#xD;
      outcomes such as time to swallowing and reduced time utilizing mechanical ventilation. This&#xD;
      study will prospectively evaluate the use of complete decongestive therapy to test the&#xD;
      hypothesis that this intervention results in improved clinical outcomes in patients with&#xD;
      blunt facial trauma.&#xD;
&#xD;
      Specific Aims Specific Aim I: To determine whether complete decongestive therapy can&#xD;
      significantly reduce facial lymphedema as measured by a previously established facial&#xD;
      composite scoring protocol.&#xD;
&#xD;
      Specific Aim II: To determine whether complete decongestive therapy can improve clinical&#xD;
      outcomes for patients with facial trauma Study Objective and Endpoints Study Objective The&#xD;
      primary objective of this study is to determine the effect(s), if any, of complete&#xD;
      decongestive therapy in the management of facial trauma.&#xD;
&#xD;
      Primary Endpoint The primary endpoint will be the composite facial score measured on the day&#xD;
      of discharge from the Trauma Neuro Critical Care (TNCC) intensive care unit (ICU) at OLOLRMC.&#xD;
      This measurement is based on the Head &amp; Neck Lymphedema (HNL) program at MD Anderson Cancer&#xD;
      Center (MDACC) whose standard evaluation protocol includes specific point-to-point&#xD;
      measurements of the face (Smith &amp; Lewin 2010; Smith and Lewin 2014). A series of key facial&#xD;
      measurements are totaled to provide a &quot;composite facial score&quot;. Based on the clinical&#xD;
      experience at MDACC with more than 150 patients, their HNL program has developed criteria to&#xD;
      define clinically detectable improvements in external HNL. Those criteria are a drop in&#xD;
      lymphedema stage or a minimum threshold of 2% reduction in the composite measurement equating&#xD;
      to at least a 2-cm change in absolute values (Smith &amp; Lewin 2014).&#xD;
&#xD;
      Secondary endpoints&#xD;
&#xD;
      Because the facial and neck composite scores only provide evaluation of the extent of edema,&#xD;
      we also seek to assess patient outcomes with regards to the following:&#xD;
&#xD;
        1. Stage of lymphedema as defined by the MDACC HNL edema rating scale&#xD;
&#xD;
        2. Number of mechanical ventilation days&#xD;
&#xD;
        3. Narcotic pain medicine utilization&#xD;
&#xD;
        4. Steroid utilization&#xD;
&#xD;
        5. Pain scale scores as determined by the Visual Analog Scale or the adult non-verbal pain&#xD;
           score&#xD;
&#xD;
        6. Time to swallowing&#xD;
&#xD;
        7. ICU length of stay (ICULOS)&#xD;
&#xD;
        8. Hospital length of stay (LOS)&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date>November 2016</start_date>
  <completion_date type="Anticipated">November 2018</completion_date>
  <primary_completion_date type="Anticipated">November 2018</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Triple (Participant, Investigator, Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Composite facial score</measure>
    <time_frame>Up to 2 weeks</time_frame>
    <description>This measurement is based on the Head &amp; Neck Lymphedema program at MD Anderson Cancer Center whose standard evaluation protocol includes specific point-to-point measurements of the face which are totaled to provide a composite facial score.</description>
  </primary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">50</enrollment>
  <condition>Post-traumatic Facial Edema</condition>
  <arm_group>
    <arm_group_label>Control Group</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>The control group will receive standard speech therapy treatments but not lymphedema treatment and will serve as the baseline for comparison for assessment of the effects of CDT.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Active Treatment Group</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>The active treatment group will receive standard speech therapy treatments in addition to complete decongestive therapy from a certified Speech Language Pathologist (CCC-SLP) trained in CDT.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Complete Decongestive Therapy (CDT)</intervention_name>
    <description>CDT is a multimodal therapy consisting of four components: manual lymph drainage, compression wrapping, exercise, and skin care</description>
    <arm_group_label>Active Treatment Group</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Adult trauma patients 18 years of age or older&#xD;
&#xD;
          -  Presence of facial trauma as determined by X-ray or computed tomography (CT)&#xD;
&#xD;
          -  Presence of face/neck lymphedema characterized as at least Stage 1 on the MD Anderson&#xD;
             Cancer Center's Head and Neck Lymphedema (HNL) rating scale&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Less than 18 years of age&#xD;
&#xD;
               -  Presence of injury to the carotid artery or jugular veins&#xD;
&#xD;
               -  Presence of upper quadrant deep vein thrombosis&#xD;
&#xD;
               -  Presence of known infection&#xD;
&#xD;
               -  Unwilling or unable to consent (or unable to find an appropriate surrogate)&#xD;
&#xD;
               -  Pregnant&#xD;
&#xD;
               -  Expected death within 24 hours of enrollment, or desire by patient of family to&#xD;
                  pursue palliative rather than aggressive, supportive care&#xD;
&#xD;
               -  Inability to speak English such that assessment of primary endpoints would not be&#xD;
                  feasible&#xD;
&#xD;
               -  Prisoners&#xD;
&#xD;
               -  Patients previously enrolled in another clinical trial&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Danielle Tatum, PhD</last_name>
    <role>Study Director</role>
    <affiliation>OUR LADY OF THE LAKE RMC</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Danielle Tatum, PhD</last_name>
    <phone>2257656649</phone>
    <email>Danielle.Tatum@ololrmc.com</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Jeffrey Gruner, MD, FACS</last_name>
    <phone>2257656893</phone>
    <email>Jeffrey.Gruner@ololrmc.com</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Our Lady of the Lake Regional Medical Center</name>
      <address>
        <city>Baton Rouge</city>
        <state>Louisiana</state>
        <zip>70808</zip>
        <country>United States</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Danielle Tatum, Ph.D.</last_name>
      <phone>225-765-6649</phone>
      <email>Danielle.Tatum@ololrmc.com</email>
    </contact>
    <contact_backup>
      <last_name>Hollis O'Neal, MD, MSc</last_name>
      <phone>225-757-4070</phone>
      <email>honeal@lsuhsc.edu</email>
    </contact_backup>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Glynn SM, Asarnow JR, Asarnow R, Shetty V, Elliot-Brown K, Black E, Belin TR. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. 2003 Jul;61(7):785-92. doi: 10.1016/s0278-2391(03)00239-8.</citation>
    <PMID>12856251</PMID>
  </reference>
  <reference>
    <citation>Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg. 2003 Jun;111(7):2140-6; discussion 2147-8. doi: 10.1097/01.PRS.0000060105.63335.0C.</citation>
    <PMID>12794453</PMID>
  </reference>
  <reference>
    <citation>Maclellan RA, Couto RA, Sullivan JE, Grant FD, Slavin SA, Greene AK. Management of Primary and Secondary Lymphedema: Analysis of 225 Referrals to a Center. Ann Plast Surg. 2015 Aug;75(2):197-200. doi: 10.1097/SAP.0000000000000022.</citation>
    <PMID>24691335</PMID>
  </reference>
  <reference>
    <citation>Glynn SM, Shetty V, Elliot-Brown K, Leathers R, Belin TR, Wang J. Chronic posttraumatic stress disorder after facial injury: a 1-year prospective cohort study. J Trauma. 2007 Feb;62(2):410-8; discussion 418. doi: 10.1097/01.ta.0000231556.05899.b0.</citation>
    <PMID>17297333</PMID>
  </reference>
  <reference>
    <citation>Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, Bosanquet N, Mortimer PS. Lymphoedema: an underestimated health problem. QJM. 2003 Oct;96(10):731-8. doi: 10.1093/qjmed/hcg126.</citation>
    <PMID>14500859</PMID>
  </reference>
  <reference>
    <citation>Cohen MD. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Phys Ther. 2011 Nov;91(11):1618-26. doi: 10.2522/ptj.20100101. Epub 2011 Aug 25.</citation>
    <PMID>21868611</PMID>
  </reference>
  <verification_date>November 2016</verification_date>
  <study_first_submitted>November 22, 2016</study_first_submitted>
  <study_first_submitted_qc>November 29, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">November 30, 2016</study_first_posted>
  <last_update_submitted>November 29, 2016</last_update_submitted>
  <last_update_submitted_qc>November 29, 2016</last_update_submitted_qc>
  <last_update_posted type="Estimate">November 30, 2016</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Our Lady of the Lake Regional Medical Center</investigator_affiliation>
    <investigator_full_name>Danielle Tatum</investigator_full_name>
    <investigator_title>Academic Research Director</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Lymphedema</mesh_term>
    <mesh_term>Facies</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02977182
org study id: 9521
nct id: NCT02977182
lead sponsor: 
has dmc: No
Injuries to the face caused by traumatic events such as motor vehicle collisions, assault,
      and falls can result in facial trauma, which can result in swelling and disfiguration that
      impairs the important functions of the face, sometimes to a life threatening degree. These
      injures and the resultant swelling can also precipitate psychological and social
      consequences.

      Lymphedema is an abnormal amount of fluid that causes swelling, usually in the arms or legs.
      The most common presentation of lymphedema is in the upper extremities due to breast cancer
      treatment (Maclellean RA et al). As such, standards of care for management of lymphedema are
      primarily derived from the cancer research literature and involve the extremities (Moffatt
      CJ. 2003 QJM). The current gold standard treatment for patients with extremity lymphedema is
      complete decongestive therapy (CDT) (Zuther 2013). CDT is a multimodal therapy consisting of
      four components: manual lymph drainage, compression wrapping, exercise, and skin care (Zuther
      2013).These same therapeutic techniques of CDT have been employed at Our Lady of the Lake
      Regional Medical Center (OLOLRMC) and adapted to treat patients with facial trauma with
      anecdotally good results primarily related to cosmesis. To the best of our knowledge, no
      clinical studies examining the effect of lymphedema treatment in the management of blunt
      facial trauma currently exist.. Beyond the consideration of cosmesis, we also seek to
      determine if this intervention improves clinical outcomes such as time to swallowing and
      reduced time utilizing mechanical ventilation. This study will prospectively evaluate the use
      of complete decongestive therapy to test the hypothesis that this intervention results in
      improved clinical outcomes in patients with blunt facial trauma.
Introduction The face is an anatomically complex structure, consisting of skin, muscles for
      both fine and gross motor functions, a complex bony structure, and vital sensory organs.
      These structures allow one to eat, breathe, see, hear, and speak. Injuries to the face caused
      by traumatic events such as motor vehicle collisions, assault, and falls can result in facial
      trauma, which can result in swelling and disfiguration that impairs the important functions
      of the face, sometimes to a life threatening degree. These injures and the resultant swelling
      can also precipitate psychological and social consequences.1-3 Lymphedema is an abnormal
      amount of fluid that causes swelling, usually in the arms or legs. Though lymphedema can
      occur as a result of trauma, it is most commonly associated with side effects of certain
      cancer-related treatments such as radiation therapy and lymph node removal. The most common
      presentation of lymphedema is in the upper extremities due to breast cancer treatment.4 As
      such, standards of care for management of lymphedema are primarily derived from the cancer
      research literature and involve the extremities.5 The current gold standard treatment for
      patients with extremity lymphedema is complete decongestive therapy (CDT).6 CDT is a
      multimodal therapy consisting of four components: manual lymph drainage, compression
      wrapping, exercise, and skin care.6 Manual lymph drainage (MLD) is a delicate form of massage
      designed to improve tissue and cellular health by facilitating fluid removal from edematous
      areas. Compression wrapping utilizes compression garments or short stretch compression
      bandages and is primarily used in the acute (or intensive) phase of CDT as a means to
      reinstate sufficient resistance to skin tissues whose elastic fibers are damaged by
      lymphedema. Exercise, especially when combined with compression, improves removal of fluid
      from the affected area. Finally, skin care treatments keep skin clean and moisturized to
      reduce infections that can occur with lymphedema.6 These same therapeutic techniques of CDT
      have been employed at Our Lady of the Lake Regional Medical Center (OLOLRMC) and adapted to
      treat facial edema in patients with facial trauma with anecdotally good results in terms of
      cosmesis. To the best of our knowledge, no clinical studies examining the effect of
      lymphedema treatment in the management of blunt facial trauma currently exist. Beyond the
      consideration of cosmesis, we also seek to determine if this intervention improves clinical
      outcomes such as time to swallowing and reduced time utilizing mechanical ventilation. This
      study will prospectively evaluate the use of complete decongestive therapy to test the
      hypothesis that this intervention results in improved clinical outcomes in patients with
      blunt facial trauma.

      Specific Aims Specific Aim I: To determine whether complete decongestive therapy can
      significantly reduce facial lymphedema as measured by a previously established facial
      composite scoring protocol.

      Specific Aim II: To determine whether complete decongestive therapy can improve clinical
      outcomes for patients with facial trauma Study Objective and Endpoints Study Objective The
      primary objective of this study is to determine the effect(s), if any, of complete
      decongestive therapy in the management of facial trauma.

      Primary Endpoint The primary endpoint will be the composite facial score measured on the day
      of discharge from the Trauma Neuro Critical Care (TNCC) intensive care unit (ICU) at OLOLRMC.
      This measurement is based on the Head & Neck Lymphedema (HNL) program at MD Anderson Cancer
      Center (MDACC) whose standard evaluation protocol includes specific point-to-point
      measurements of the face (Smith & Lewin 2010; Smith and Lewin 2014). A series of key facial
      measurements are totaled to provide a "composite facial score". Based on the clinical
      experience at MDACC with more than 150 patients, their HNL program has developed criteria to
      define clinically detectable improvements in external HNL. Those criteria are a drop in
      lymphedema stage or a minimum threshold of 2% reduction in the composite measurement equating
      to at least a 2-cm change in absolute values (Smith & Lewin 2014).

      Secondary endpoints

      Because the facial and neck composite scores only provide evaluation of the extent of edema,
      we also seek to assess patient outcomes with regards to the following:

        1. Stage of lymphedema as defined by the MDACC HNL edema rating scale

        2. Number of mechanical ventilation days

        3. Narcotic pain medicine utilization

        4. Steroid utilization

        5. Pain scale scores as determined by the Visual Analog Scale or the adult non-verbal pain
           score

        6. Time to swallowing

        7. ICU length of stay (ICULOS)

        8. Hospital length of stay (LOS)
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Triple (Participant, Investigator, Outcomes Assessor)
measure: Composite facial score
time frame: Up to 2 weeks
description: This measurement is based on the Head & Neck Lymphedema program at MD Anderson Cancer Center whose standard evaluation protocol includes specific point-to-point measurements of the face which are totaled to provide a composite facial score.
arm group label: Control Group
arm group type: No Intervention
description: The control group will receive standard speech therapy treatments but not lymphedema treatment and will serve as the baseline for comparison for assessment of the effects of CDT.
arm group label: Active Treatment Group
arm group type: Experimental
description: The active treatment group will receive standard speech therapy treatments in addition to complete decongestive therapy from a certified Speech Language Pathologist (CCC-SLP) trained in CDT.
intervention type: Other
intervention name: Complete Decongestive Therapy (CDT)
description: CDT is a multimodal therapy consisting of four components: manual lymph drainage, compression wrapping, exercise, and skin care
arm group label: Active Treatment Group
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Danielle Tatum, PhD
role: Study Director
affiliation: OUR LADY OF THE LAKE RMC
last name: Danielle Tatum, PhD
phone: 2257656649
email: Danielle.Tatum@ololrmc.com
last name: Jeffrey Gruner, MD, FACS
phone: 2257656893
email: Jeffrey.Gruner@ololrmc.com
facility: 
status: Recruiting
contact: 
contact backup: 
country: United States
citation: Glynn SM, Asarnow JR, Asarnow R, Shetty V, Elliot-Brown K, Black E, Belin TR. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. 2003 Jul;61(7):785-92. doi: 10.1016/s0278-2391(03)00239-8.
PMID: 12856251
citation: Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg. 2003 Jun;111(7):2140-6; discussion 2147-8. doi: 10.1097/01.PRS.0000060105.63335.0C.
PMID: 12794453
citation: Maclellan RA, Couto RA, Sullivan JE, Grant FD, Slavin SA, Greene AK. Management of Primary and Secondary Lymphedema: Analysis of 225 Referrals to a Center. Ann Plast Surg. 2015 Aug;75(2):197-200. doi: 10.1097/SAP.0000000000000022.
PMID: 24691335
citation: Glynn SM, Shetty V, Elliot-Brown K, Leathers R, Belin TR, Wang J. Chronic posttraumatic stress disorder after facial injury: a 1-year prospective cohort study. J Trauma. 2007 Feb;62(2):410-8; discussion 418. doi: 10.1097/01.ta.0000231556.05899.b0.
PMID: 17297333
citation: Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, Bosanquet N, Mortimer PS. Lymphoedema: an underestimated health problem. QJM. 2003 Oct;96(10):731-8. doi: 10.1093/qjmed/hcg126.
PMID: 14500859
citation: Cohen MD. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Phys Ther. 2011 Nov;91(11):1618-26. doi: 10.2522/ptj.20100101. Epub 2011 Aug 25.
PMID: 21868611
responsible party type: Principal Investigator
investigator affiliation: Our Lady of the Lake Regional Medical Center
investigator full name: Danielle Tatum
investigator title: Academic Research Director
mesh term: Lymphedema
mesh term: Facies
sharing ipd: No