Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis

Yamamoto, Takumi; Iida, Takuya; Yoshimatsu, Hironobu; Fuse, Yuma; Hayashi, Akitatsu; Yamamoto, Naoki

doi:10.1097/prs.0000000000004694

Cited by 79 publications

(47 citation statements)

References 35 publications

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“…Scaglioni et al reported the use of a combined pedicled superficial circumflex iliac artery perforator flap with LVA in defect reconstruction to prevent the development of lymphatic disorders and lymphorrea 18) . Yamamoto et al suggested tissue replantation or free flap transfer without lymph node or s-LVA to restore the lymph flow and reported success in 63% of the cases 19) . Guillier et al proposed in their article for lymphatic disorder the combination of pedicle flap with lympho-venous bypass as a lymphatic derivation concept that can improve the chronic morbidity scenarios of lymphatic complications 20) .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Supramicrosurgical Lymphatico-venular Anastomosis in Treating Recurrent Lymphatic Fistulas: A Case Series

Gennaro

Chisci

Cascino³

et al. 2023

JPRS

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Objective: Lymphatic fistula is a complication that may occur in all cases where lymphostasis arise, due to a damage to the lymphatic drainage system. The current study evaluates the effectiveness of supramicrosurgical lymphaticovenular anastomosis (s-LVA) for treating lymphatic fistula. Patients and Methods: This is a retrospective study that aims to evaluate the effectiveness of s-LVA in treating lymphatic fistula. The inclusion criterion was the presence of persistent chronic lymphatic fistula; the exclusion criteria were refuse of the patient, terminal patients. All patients presented with lymphatic fistula. To evaluate lymphatic patency, indocyanine green (ICG) lymphography was performed in preoperative, immediately afterward and 1 month after s-LVA. Postoperative follow-up was performed for 1 year. The site for skin incision was selected on the basis of the ICG lymphography and the venous mapping. s-LVA was performed with 11-0 sutures using an operating microscope. Afterward, the skin incision was sutured with 6-0 absorbable sutures. Results: Eight patients (five males and three females) were enrolled in this study. Lymphatic vessels identified during s-LVA resulted ectasic. ICG lymphography demostrated patency of the anastomosis in all patients since the first postoperative day except one case, where the anastomosis resulted patent 1 month after s-LVA. No clinical complications were reported during the postoperative follow-up: no cellulitis and no recurrence of the fistula occurred in the year after s-LVA. Total recovery of fistula was observed and confirmed for the year after the intervention. Conclusions: This study evidenced positive results with lymphorrhea interruption and recovery of the fistula after the intervention.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Supramicrosurgical Lymphatico-venular Anastomosis in Treating Recurrent Lymphatic Fistulas: A Case Series

Gennaro

Chisci

Cascino³

et al. 2023

JPRS

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“…6 11 18 26 27 28 30 34 35 Although all previous studies are on extremity lymphedema cases and no study reports on BL cases, similar findings can be expected in BL cases; early diagnosis of BL with ICG lymphography and appropriate interventions may improve prognosis of BL. 6 14 23 26 28 30 36 37…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Lymphography for Evaluation of Breast Lymphedema Secondary to Breast Cancer Treatments

Yamamoto

2022

J Reconstr Microsurg

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Background Although breast lymphedema (BL) significantly deteriorates quality of life (QOL) of breast cancer survivors, little is known and pathophysiological severity staging system is yet reported. This study aimed to evaluate usefulness of a novel BL severity staging system based on indocyanine green (ICG) lymphography findings. Methods Breast cancer survivors with breast symptoms who underwent breast ICG lymphography were included. Breast ICG lymphography stage was determined based on visibility of linear pattern and extension of dermal backflow patterns. Prevalence of breast symptoms and lymphedema QOL score (LeQOLiS) was compared according to the stage. Results Thirty-seven patients were included. Breast ICG lymphography stage included stage 0 in 11 (29.7%) cases, stage I in 3 (8.1%) cases, stage II in 11 (29.7%) cases, stage III in 6 (16.2%) cases, stage IV in 4 (10.8%) cases, and stage V in 2 (5.4%) cases. Higher ICG stages were associated with more frequent prevalence of breast swelling (p = 0.020), breast pain (p = 0.238), and breast cellulitis (p = 0.024), and with higher LeQOLiS (p < 0.001). Conclusion ICG lymphography allows clear visualization of superficial lymph circulation in the breast. Higher breast ICG lymphography stages are associated with more frequent prevalence of BL-related symptoms and worse QOL.

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“…Lymphedema is a chronic condition of lymphatic impairment commonly caused by infection, surgery, or radiation therapy [1][2][3][4]. Inflammation caused by local immune insufficiency and abnormal lipid profiles also result in lymphatic impairment [5][6][7][8][9]. Disrupted lymphatic flow leads to fluid accumulation in the regional interstitium that could result in cellular proliferation, fibrosis, adipose 상지에서의 혈관성 림프절 전이술의 미용적 삽입을 위한 새로운 수용부: 초기 결과 tissue hypertrophy, and skin breakdown [2,10].…”

Section: Introductionmentioning

confidence: 99%

“…Disrupted lymphatic flow leads to fluid accumulation in the regional interstitium that could result in cellular proliferation, fibrosis, adipose 상지에서의 혈관성 림프절 전이술의 미용적 삽입을 위한 새로운 수용부: 초기 결과 tissue hypertrophy, and skin breakdown [2,10]. Owing to the chronic edematous conditions and inflammation, the postoperative rehabilitation and quality of life of lymphedema patients, approximately > 250 million worldwide, are affected [2,5]. Despite the high incidence of lymphedema, it remains a challenge for reconstructive surgeons due to the lack of curative treatment options [1].…”

Section: Introductionmentioning

confidence: 99%

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

Yi¹,

Park²,

Seo³

et al. 2021

Arch Hand Microsurg

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Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).Conclusion: The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.

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Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis

Abstract: Therapeutic, IV.

Cited by 79 publications

References 35 publications

Effectiveness of Supramicrosurgical Lymphatico-venular Anastomosis in Treating Recurrent Lymphatic Fistulas: A Case Series

Effectiveness of Supramicrosurgical Lymphatico-venular Anastomosis in Treating Recurrent Lymphatic Fistulas: A Case Series

Indocyanine Green Lymphography for Evaluation of Breast Lymphedema Secondary to Breast Cancer Treatments

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

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