Anti-inflammatory effects of flap and lymph node transfer

Abstract

Transfer of healthy tissue hinders the proinflammatory response after surgery, which may explain the beneficial effects of flap transfer in various patient groups. In addition, flap transfer with lymph nodes seems to also promote an antifibrotic effect. The clinical effects of LN in lymphedema patients may be mediated by the increased production of prolymphangiogenic growth factor (VEGF-C) and antifibrotic cytokine (IL-10).

New and Emerging Treatments for Lymphedema

“…53 In another study examining axillary wound exudate samples in patients following lymph node transfer, the levels of the anti-inflammatory and anti-fibrotic cytokine IL-10, as well as VEGF-C, were increased. 54 Of note, expression of VEGF-C is markedly increased in lymphedematous tissues, suggesting that formation of collateral lymphatics in this scenario is actively inhibited, 27 possibly by T cell-derived cytokines decreasing the responsiveness of LECs to lymphangiogenic growth factors. 15 In addition, in a porcine LE model using aligned nanofibrillar collagen scaffolds positioned across the area of lymphatic obstruction, coating the scaffold with VEGF-C impeded the functional therapeutic response, with the development of nonfunctional vascular proliferation in the presence of VEGF-C-coated threads.…”

Deep inferior epigastric lymph node basin: Analysis of novel donor site for vascularized lymph node transfer among 10 consecutive patients

“…VLNTs are based on the concept of implantation of healthy lymph node tissue into extremities where the lymphatic system has been disrupted, or where the lymph nodes are absent secondary to surgical intervention. The mechanism of how VLNTs function in reducing extremity lymphedema is still debated, but 3 primary theories that have been proposed: (1) release of obstructive scar tissue at recipient sites, (2) hydrostatic “pumping” where the lymph node acts as a pump via arterial inflow and venous outflow, and (3) lymphangiogenesis through growth factors such as VEGF‐C produced by the healthy transplanted lymph node tissue (Chang & Kim, ; Cheng et al, ; Ito & Suami, ; Patel, Lin, & Cheng, ; Viitanen, Visuri, Sulo, Saarikko, & Hartiala, ). Despite an ill‐defined mechanism of action, VLNTs have shown some promising results in the treatment of lymphedema (Nguyen et al, ).…”

Heating and Compression Bandage Treatment Is Effective for Chronic Lymphedema with Dermatolymphangioadenitis—A Case-Controlled Study

“…DLA is usually caused by coagulase-negative Staphylococci with S. epidermidis being the usual dominant organism involved. [2][3][4] Surgical treatment options for lymphedema include lymphatico-venous anastomoses, 5 free lymph node flap transfer, 6 and laser-assisted liposuction. 7 Some of these techniques require the use of microsurgery and may be associated with a small risk of producing donor site lymphedema.…”