Experimental Assessment of Autologous Lymph Node Transplantation as Treatment of Postsurgical Lymphedema

Tobbia, Dalia; Semple, John L.; Baker, A. G.; Dumont, Dan; Johnston, Mary

doi:10.1097/prs.0b013e3181b03787

Cited by 83 publications

(63 citation statements)

References 29 publications

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“…and non-superiority of one technique leaves most experts to regard these procedures as experimental, thus warranting further investigation [13,18]. Consequently, the mainstay of lymphedema management today largely consists of conservative modalities including manual lymphatic drainage, exercise, pneumatic pumps, and compression bandage therapy.…”

Section: Journal Of Aesthetic and Reconstructive Surgery Issn 2472-1905mentioning

confidence: 99%

“…The mean limb volume was reduced by 57% in the experimental group treated with VLNT versus 18% in the non-surgical control group. Additionally, the rate of infection significantly decreased in the surgically treated group [13,14]. Most recently, a systematic review of 18 studies and 305 patients undergoing VLNT reported improved quality of life in all patients, with 91% improvement of limb circumference, 86% with reduced limb volume, and 60% with improved lymphatic flow [15][16][17][18].…”

Section: Vlntmentioning

confidence: 99%

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Surgical Treatment Modalities for Lymphedema

Lee¹,

DP²,

Bouz³

2016

J Aesthet Reconstr Surg

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Section: Journal Of Aesthetic and Reconstructive Surgery Issn 2472-1905mentioning

confidence: 99%

Section: Vlntmentioning

confidence: 99%

Surgical Treatment Modalities for Lymphedema

Lee¹,

DP²,

Bouz³

2016

J Aesthet Reconstr Surg

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“…Direct healing of transplanted lymphatics has been shown to occur in animal models and in vivo in transplanted free flaps and likely accounts for some of the improvements observed and the success found by those using recipient sites such as the wrist or ankle. 34,38,39 The main disadvantage of the VLNT procedure is the potential but unlikely risk for donor site morbidity. Careful selection and collection of lymphatics during the procedure is used to minimize risk of disturbing lymphatics at the donor site.…”

Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

Review of Current Surgical Treatments for Lymphedema

et al. 2014

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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.

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“…13 Lymphatic function 8 to 12 weeks after transfer was significantly higher in the vascularized group. Similarly, postoperative edema was less in the vascularized versus avascular lymph node transfer group; however, it failed to register significance.…”

Section: Experimental Studiesmentioning

confidence: 96%

Vascularized Lymph Node Transfer

Tourani

Taylor

Ashton

2016

Plastic and Reconstructive Surgery

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Over the past decade, lymph node transfer has rapidly gained popularity among plastic surgeons for the treatment of chronic lymphedema because of the initial promising results and its unique technical advantages compared with the other reconstructive options. However, its functional mechanism is still a matter of great debate, and some concerning reports have emerged regarding the safety of this procedure in patients with chronic lymphedema. The authors review the literature on the experimental and clinical evidence for lymph node transfer, discuss its proposed functional mechanisms, review the potential risk of iatrogenic lymphedema following this procedure, and discuss the suggested strategies to avoid this complication.

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Experimental Assessment of Autologous Lymph Node Transplantation as Treatment of Postsurgical Lymphedema

Abstract: The successful reimplantation of a lymph node into a nodal excision site has the potential to restore lymphatic function and facilitate edema resolution. This result has important conceptual implications in the treatment of postsurgical lymphedema.

Cited by 83 publications

References 29 publications

Surgical Treatment Modalities for Lymphedema

Surgical Treatment Modalities for Lymphedema

Review of Current Surgical Treatments for Lymphedema

Vascularized Lymph Node Transfer

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