Comprehensive review of vascularized lymph node transfers for lymphedema: Outcomes and complications

Scaglioni, Mario F.; Arvanitakis, Michael; Chen, Yen-Chou; Giovanoli, Pietro; Yang, Johnson Chia‐Shen; Chang, Edward I.

doi:10.1002/micr.30079

Cited by 174 publications

(168 citation statements)

References 50 publications

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“…For patients with advanced stage lymphedema, conservative therapy is often ineffective and surgical management is required . Surgical approaches can be divided into physiological and excisional .…”

Section: Discussionmentioning

confidence: 99%

“…Regarding VLNT, various donor site options have been described for lymph node flap harvest such as the groin, submental, supraclavicular, lateral thoracic, gastroepiploic, jejunal, appendicular, and ileocecal areas . Although there have been satisfactory results with all VLNTs described in the literature, there are still some concerns regarding recipient and donor site morbidity, and iatrogenic lymphedema after the lymph node harvest . At this time, the ideal lymph node flap has not been determined.…”

Section: Discussionmentioning

confidence: 99%

“…Selection of recipient site in VLNT is somewhat controversial . Orthotopic VLNT to the axilla and groin in patients with previous axillary or inguinal lymph node dissection allows for the re‐establishment of the lymphatic network in the area through the local lymphangiogenetic effect of the transferred lymph node flap.…”

Section: Discussionmentioning

confidence: 99%

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Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Ciudad

Manrique

Adabi

et al. 2019

Journal of Surgical Oncology

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Background Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals. Methods Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed. Results All flaps survived. The mean follow‐up period was 14.2 months (range, 12‐19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7‐fold quality‐of‐life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases. Conclusion Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients’ quality of life in the advanced stages of lymphedema.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Ciudad

Manrique

Adabi

et al. 2019

Journal of Surgical Oncology

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“…In some areas of the US, pneumatic compression devices may be covered by insurers, but the patient must first fail using a basic PCT pump before being allowed to try an advanced pump. Lymphaticovenous anastomoses and lymph node transplant surgeries have been performed on selected lymphedema patients, and have demonstrated decreased cellulitis incidence and limb swelling in many cases [9–14]. Compression garment use after the surgeries is still required to maintain limb volume reductions in most cases to prevent further lymph and subcutaneous adipose accumulation.…”

Section: Introductionmentioning

confidence: 99%

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging

Aldrich

Gross²,

Morrow

et al. 2017

J. Innov. Opt. Health Sci.

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Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT). Optically transparent and windowed PCT garments allowed visualization of lymph movement during single, one-hour PCT treatment sessions. Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects. In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies, these values were significantly increased during and after PCT as compared to pre-treatment values. Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT. Direct visualization revealed increased lymphatic function, during and after PCT therapy, in all lymphedema-affected extremities. Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.

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“…Donor site complications including iatrogenic lymphedema, lymphocele, and persistent pain have previously been reported . But the most common donor site complication following inguinal node harvest is chronic seroma, as removal of nodes leaves a dead space in the groin. One effort to eliminate dead space at the lymph node donor site has included placement of quilting sutures.…”

mentioning

confidence: 99%

Abdominal flap for closing the donor site after groin lymph node transfer

Maldonado

Garza

Artz

et al. 2017

Journal of Surgical Oncology

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Comprehensive review of vascularized lymph node transfers for lymphedema: Outcomes and complications

Cited by 174 publications

References 50 publications

Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging

Abdominal flap for closing the donor site after groin lymph node transfer

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