Donor-Site Lymphatic Function after Microvascular Lymph Node Transfer

Viitanen, Tiina P.; Mäki, Maija; Seppänen, Marko; Suominen, Erkki; Saaristo, Anne

doi:10.1097/prs.0b013e31826d1682

Cited by 142 publications

(98 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25,26 In contrast, the connections between lymphatics and nearby veins in LVA procedures typically are superficial and require only a fraction of the lymphatics in the affected limb. In this series, we opted for VLNT over LVA in patients with upper extremity lymphedema because we believed that the risk of donor site lymphedema may be lower when harvesting from the groin compared with the axilla or chest wall.…”

Section: Discussionmentioning

confidence: 99%

An Effective System of Surgical Treatment of Lymphedema

et al. 2014

View full text Add to dashboard Cite

Background. Effective surgical treatments for lymphedema now can address the fluid and solid phases of the disease process. Microsurgical procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), target the fluid component that predominates at earlier stages of the disease. Suctionassisted protein lipectomy (SAPL) addresses the solid component that typically presents later as chronic, nonpitting lymphedema of an extremity. We assess the outcomes of patients who underwent selective application of these three surgical procedures as part of an effective system to treat lymphedema. Methods. This is a retrospective chart review of patients with lymphedema who underwent complete decongestive therapy followed by surgical treatment with SAPL, LVA, or VLNT. The primary outcomes measured were postoperative volume reduction (SAPL), daily requirement for compression garments and lymphedema therapy (VLNT and LVA), and the incidence of severe cellulitis. Results. Twenty-six patients were included in the study, of which 10 underwent SAPL and 16 underwent LVA or VLNT. The average reduction of excess volume by SAPL was 3,212 mL in legs and 943 mL in arms, or a volume reduction of 87 and 111 %, respectively, when compared with the unaffected, opposite sides. Microsurgical procedures (VLNT and LVA) significantly reduced the need for both compression garment use (p = 0.003) and lymphedema therapy (p \ 0.0001). The overall rate of cellulitis decreased from 58 % before surgery to 15 % after surgery (p \ 0.0001).Conclusions. When applied appropriately to properly selected patients, surgical procedures used in the treatment of lymphedema are effective and safe.Lymphedema in the developed world commonly occurs after lymph node dissection and/or radiotherapy to nodal basins for breast cancer, melanoma, or gynecologic malignancies. Less commonly, lymphedema occurs as a result of congenital causes.

show abstract

Section: Discussionmentioning

confidence: 99%

An Effective System of Surgical Treatment of Lymphedema

et al. 2014

View full text Add to dashboard Cite

show abstract

“…However, one study reported a small change in the postoperative lymphoscintigraphies in donor site legs, and another study described new-onset lymphedema in donor limbs. 40,41 Intraoperative laser imaging of lymph nodes with indocyanine green dye can guide selective VLNT lymph node collection. Sentinel lymph node mapping of donor sites with technetium tracer and the collection of lymph nodes other than the sentinel nodes can further improve safety (Fig.…”

Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

Review of Current Surgical Treatments for Lymphedema

et al. 2014

View full text Add to dashboard Cite

Background. The current mainstay of lymphedema therapy has been conservative nonsurgical treatment. However, surgical options for lymphedema have been reported for over a century. Early surgical procedures were often invasive and disfiguring, and they often had only limited long-term success. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garment use and lymphedema therapy. Microsurgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer lymphaticolymphatic bypass can treat the excess fluid component of lymphedema swelling that presents as pitting edema. Suction-assisted protein lipectomy is a minimally invasive procedure that addresses the solid component of lymphedema swelling that typically occurs later in the disease process and presents as chronic nonpitting lymphedema. These surgical techniques are becoming increasingly popular and their success continues to be documented in the medical literature. We review the efficacy and limitations of these contemporary surgical procedures for lymphedema. Methods. A Medline literature review was performed of lymphedema surgery, vascularized lymph node transfer, lymphaticovenous anastomosis, lymphatic liposuction, and lymphaticolymphatic bypass with particular emphasis on developments within the past 10 years. A literature review of technique, indications, and outcomes of the surgical treatments for lymphedema was undertaken.Results. Surgical treatments have evolved to become less invasive and more effective. Conclusions. With proper diagnosis and the appropriate selection of procedure, surgical techniques can be used to treat lymphedema safely and effectively in many patients when combined with integrated lymphedema therapy.Lymphedema is a progressive and debilitating condition associated with dysfunction of the lymphatic system. While a small percentage of cases are congenital, most patients in developed countries present with lymphedema resulting from treatment of malignancy. The true incidence of lymphedema is difficult to determine as a result of significant differences in diagnostic criteria. However, lymphedema is reported to occur in up to 49 % of breast, 20 % of gynecologic, 16 % of melanoma, 10 % of genitourinary, and 6 % head and neck cancer patients after lymph node dissection and/or radiotherapy. Even among patients who undergo isolated axillary sentinel lymph node biopsy, up to 7 % have measurable arm differences, and up to 10 % have subjective symptoms of lymphedema.

show abstract

“…The superficial inguinal lymph nodes are fed by the SCIA, SIEA, and the medial artery [4]. Recent studies have shown that nodes in the inferior-medial and the central areas of the saphenofemoral junction should not be selected as donor sites for VLNT, because they are the primary superficial nodes draining the lower limb [2,3]. Nodes in the superior area of the saphenofemoral junction are said to be safe, but they can be the draining nodes for the lower limb in 15% of the cases [3].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that nodes in the inferior-medial and the central areas of the saphenofemoral junction should not be selected as donor sites for VLNT, because they are the primary superficial nodes draining the lower limb [2,3]. Nodes in the superior area of the saphenofemoral junction are said to be safe, but they can be the draining nodes for the lower limb in 15% of the cases [3]. Scaglioni et al [5] showed that the superficial inguinal lymph nodes could be divided into three subgroups: abdominal, medial thigh, and lateral thigh nodes.…”

Section: Discussionmentioning

confidence: 99%

“…These nodes enable simultaneous VLNT and breast reconstruction by transferring an abdominal flap containing the inguinal lymph nodes. Recent reports suggest that to avoid donor site iatrogenic lymphedema, superficial inguinal nodes superior to the saphenous junction are suitable [2,3]. Our study aimed to identify how many nodes could be included in the abdominal flap.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation