Abstract
Upper limb lymphedema is a common complication after breast cancer surgery and may substantially impair upper limb function and quality of life. In clinical rehabilitation practice, external application of Sizi Powder combined with TDP therapy has been used as an adjunctive intervention; however, the available clinical evidence remains limited. This study aimed to evaluate the efficacy and safety of Sizi Powder external application combined with TDP therapy in patients with upper limb lymphedema after breast cancer surgery. This single-center retrospective cohort study included 86 patients with unilateral upper limb lymphedema after breast cancer surgery. According to the treatment received in routine clinical practice, patients were assigned to either a combination group treated with Sizi Powder external application plus TDP therapy (n = 44) or a control group receiving conventional rehabilitation management alone (n = 42). Outcome measures included changes in arm circumference difference, symptom scores, upper limb functional indicators, overall treatment response, and treatment-related adverse events. Multivariable logistic regression analysis was further performed to identify factors associated with clinical improvement. Both groups showed improvement after treatment, whereas the combination group demonstrated greater reductions in arm circumference difference at the wrist, 10 cm below the elbow, the elbow, and 10 cm above the elbow. Posttreatment swelling, pain, and heaviness scores were significantly lower in the combination group than in the control group. In addition, shoulder flexion, shoulder abduction, and DASH score improved more markedly in the combination group. Although the overall response rate was higher in the combination group than in the control group, the between-group difference did not reach statistical significance. Adverse events were mild and infrequent in both groups, and no serious treatment-related adverse events were observed. After adjustment for selected baseline covariates, combination treatment remained significantly associated with clinical improvement. Sizi Powder external application combined with TDP therapy may be a safe and beneficial adjunctive intervention for patients with upper limb lymphedema after breast cancer surgery, particularly in reducing swelling, alleviating symptom burden, and improving selected functional outcomes. Larger prospective studies are warranted to further confirm these findings.