Donor-Site Lymphedema Following Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review of the Literature

Demiri, Efterpi; Dionyssiou, Dimitrios; Tsimponis, Antonios; Goula, Olga Christina; Mιlothridis, Panagiotis; Pavlidis, Leonidas; Spyropoulou, Georgia‐Alexandra; Foroglou, Pericles

doi:10.1089/lrb.2017.0043

Cited by 45 publications

(34 citation statements)

References 30 publications

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“…Although the SPECT‐CT examination is costly and involves extra radiation for the patient, in comparison with the plane Tc99 lymphoscintigraphy, it provides significant and important information for lymphedema diagnosis . In addition, the SPECT‐CT, which anyway is performed for diagnostic purpose, may constitute the one and only required preoperative examination, using also the results for preplanning the appropriate selected LN flap.…”

Section: Discussionmentioning

confidence: 99%

“…Although numerous studies confirm the efficacy of LNT in lymphedema treatment, its application still remains a subject of discussion and skepticism due to the unpredictable positive outcome and the potential risk of donor‐site morbidity such as iatrogenic donor‐site lymphedema, lymphocele, testicular hydrocele, and persistent regional pain of the donor area . Review of the literature describes the safety of the procedure but there still remains a reported risk of 1.6% donor‐site lymphedema …”

Section: Introductionmentioning

confidence: 99%

“…5,6,11,12 Review of the literature describes the safety of the procedure but there still remains a reported risk of 1.6% donor-site lymphedema. [13][14][15] Searching for the ideal vascularized lymph node (LN) groin flap, Zeltzer et al 16 suggested to: (a) design the flap using known anatomic landmarks, (b) include a group of LNs, (c) avoid harvest or damage the lymphatics, which drain the ipsilateral extremity, and (d) provide a long vascular pedicle. In an effort to improve the anatomical knowledge of the groin area, various preoperative examinations have been described, aiming to reduce donor-site morbidity and choose the most suitable LN flap.…”

Section: Introductionmentioning

confidence: 99%

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Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Dionyssiou

Demiri

Sarafis

et al. 2019

Journal of Surgical Oncology

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Background A new technique named “Selected Lymph Node” (“SeLyN”) was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. Methods Bilateral lower‐limb SPECT‐CT was performed in the upper‐limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor‐site complications were recorded and lower‐limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. Results A total of 41 patients underwent a “SeLyN” transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow‐up period of 42.5 months. Conclusions “SeLyN” is a safe and effective technique in selecting the most suitable LNs, minimizing the donor‐site morbidity, and decreasing the overall operating time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Dionyssiou

Demiri

Sarafis

et al. 2019

Journal of Surgical Oncology

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“…Daher wird ein "reverse mapping" der Entnahmeregion zur Reduktion von Spendermorbidität (iatrogenes Lymphödem) als obligat betrachtet [46,47]. Insbesondere bei der Entnahme von Leistenlymphknoten oder Axilla-nahen Lymphknoten besteht ein Risiko für die Entwicklung eines Hebedefektlymphödems, das in einer Meta-Analyse von Demiri et al unter Einschluss von 11 Studien und 189 Patienten mit drei publizierten Ereignissen mit 1,6 % auftrat [48]. Darüber hinaus wurde vor diesem Hintergrund gezeigt, dass der lymphatische Transportindex in 20 % (n = 2 von 10) und der lymphatische Fluss in 60 % (n = 6 von 10) in der Entnahmeregion des Lymphknotenlappens geringfügig verändert war [49], ohne jedoch eine sichtbare Schwellung bzw.…”

Section: Mögliche Entnahmeregionenunclassified

Rekonstruktive Mikrochirurgie des sekundären Lymphödems: Konsensus der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) zur Indikation, Diagnostik und Therapie mittels Lymphovenöser Anastomosen (LVA) und vaskularisierter Lymphknotentransplantation (VLKT)

Hirche

Engel

Seidenstuecker

et al. 2019

Handchir Mikrochir plast Chir

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ZusammenfassungDas sekundäre Lymphödem ist eine komplexe Erkrankung, die durch chronische Inflammation und reduzierte Immunkompetenz, Ansammlung von Lymphflüssigkeit und Proteinablagerungen sowie sekundärer Fettablagerung und Fibrosierung bei der Stadienmigration charakterisiert ist. Während die Domäne der Behandlung immer noch eine lebenslange komplexe physikalische Entstauungstherapie (KPE) ist, wird der Fokus auf chirurgische Verfahren zur physiologischen Rekonstruktion gesetzt. Die lymphovenösen Anastomosen (LVA) und die freie, vaskularisierte Lymphknotentransplantation (VLKT) sind die am verbreitetsten angewendeten, rekonstruktiven Techniken, die die Wiederherstellung oder Verbesserung der physiologischen Lymphtransportkapzität adressieren. Der vorliegende Artikel fasst die Empfehlungen eines Expertenpanels zur Diagnostik, Indikation und Therapie von LVA und VLKT bei sekundären Lymphödemen während der 40. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) in Lugano, Schweiz, zusammen und diskutiert sie. Das Expertengremium befasste sich mit der Diagnostik für die lymphorekonstruktive Chirurgie, einschließlich der essentiellen Anwendung der Fluoreszenz-Lymphangiographie mit Indocyaningrün (ICG) und der intraoperativen Navigation für beide Techniken sowie dem „reverse mapping“, um die Rate des Hebestellen-Lymphödems nach VLKT zu reduzieren, sowie die Verwendung von Lymphödem-spezifischen Fragebögen zur Lebensqualität. Sowohl LVA als auch VLKT werden einschließlich Tipps und Tricks zur Identifizierung funktioneller Lymphkollektoren, Ausrüstung, Anastomosenarten und Dokumentation für LVA sowie Auswahl der Spender- und Empfängerstelle, Anzahl der inkludierten Lymphknoten und Herangehensweise an spezifische Spenderstellen, wie z. B. jejunal-mesenterial für den VLKT, beschrieben. Die synchrone und sequentielle Anwendung von LVA, VLKT und/oder ablativer Liposuktion wird vor dem Hintergrund der Wirksamkeit und Morbidität diskutiert. Schließlich werden Empfehlungen zur postoperativen Behandlung und Diagnostik erörtert. Die vorliegende Konsensusarbeit adressiert eine Erhöhung des Standardisierungsgrades der Behandlung für weitere multizentrische Studien im deutschsprachigen Raum in diesem aufstrebenden Gebiet der Lymphödemtherapie.

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“…Donor sites for this procedure most commonly include the axilla/thoracic region, groin, omentum, submental area, and supraclavicular area (Althubaiti, Crosby, & Chang, ; Becker, Assouad, Riquet, & Hidden, ; Cheng, Huang, Huang, et al, ; Ciudad et al, ; Gharb et al, ; Lin et al, ; Mardonado, Chen, & Chang, ; Sapountzis et al, ). One fear with the non‐abdominal donor sites, however, is the possibility of inducing iatrogenic lymphedema to the donor site (Demiri et al, ; Pons, Masia, Loschi, Nardulli, & Duch, ; Vignes, Blanchard, Yannoutsos, & Arrault, ). Vignes et al described their experience with this technique, reporting a 23% rate of donor extremity lymphedema persisting an average of 40 months postoperatively (Vignes et al, ).…”

Section: Introductionmentioning

confidence: 99%

Complications after vascularized jejunal mesenteric lymph node transfer: A 3‐year experience

et al. 2019

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Background: Vascularized lymph node transfer (VLNT) is a well-established method for the surgical management of refractory extremity lymphedema. Generally, donor lymph nodes are harvested from the axilla, groin, or supraclavicular area. However, these sites offer their own disadvantages and introduce risk for inducing lymphedema at the surgical donor site. In our experience, the jejunal mesentery can be an excellent source of lymph nodes without the risk of donor site lymphedema. Long term complications are unknown for this procedure; we report our experience, complication rates, and lessons learned. Methods: A retrospective review was performed for all patients at our institution undergoing surgical treatment of lymphedema using jejunal mesenteric VLNT from February 2015 to February 2018. Demographic data, length of follow up, and surgical complications were reviewed. Results: Twenty-nine patients have undergone jejunal VLNT at our institution during the three-year study period, with a total of 30 transfers. Five patients had a concurrent omental lymph node transfer. Average length of follow up was 17.6 months (range 1.0-36.8 months). There was one flap loss in this time frame (3.3%). Four patients developed hernias post-operatively (13.8%), and three had nonoperative small bowel obstructions (10.3%). One patient had a postoperative wound infection at the abdominal incision (3.4%). Conclusions: Jejunal VLNT can be an effective option for surgical treatment of lymphedema, without the risk of postoperative donor site lymphedema. Patients and surgeons should be aware of the risks of hernia and small bowel obstruction with this method compared to other lymph node sources.

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Donor-Site Lymphedema Following Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review of the Literature

Cited by 45 publications

References 30 publications

Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Complications after vascularized jejunal mesenteric lymph node transfer: A 3‐year experience

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