Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb

Gentileschi, Stefano; Servillo, Maria; Albanese, Roberta; Bonis, Francesca De; Tartaglione, Girolamo; Salgarello, Marzia

doi:10.1002/micr.30247

Cited by 37 publications

(38 citation statements)

References 23 publications

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“…In both studies, all subscales and the overall quality of life improved significantly (p < 0.01). Gentileschi et al reported a significant increase in the average overall score using the LYMQOL at 6 months after LVB for treatment of upper extremity lymphedema in 16 patients (p < 0.001) [38]. Salgarello et al used the LYMQOL to evaluate outcomes of LVB for treatments of either upper extremity (n = 44) or lower extremity (n = 26) lymphedema at an average of 8.5 months [39].…”

Section: Lymqolmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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Introduction: Analysis of quality of life (QOL) outcomes is an important aspect of lymphedema treatment since this disease can substantially impact QOL in affected individuals. There are a growing number of studies reporting patient-reported outcomes (PROMs) for patients with lymphedema. The purpose of this study was to conduct a systematic review of outcomes and utilization of PROMs following surgical treatment of lymphedema. Methods: A literature search of four databases was performed up to and including March, 2019. Studies included reported on QOL outcomes after physiologic procedures, defined as either lymphovenous bypass (LVB) or vascularized lymph node transplant (VLNT), to treat upper and/or lower extremity primary or secondary lymphedema. Results: In total, 850 studies were screened—of which, 32 studies were included in this review. Lymphovenous bypass was the surgical intervention in 16 studies, VLNT in 11 studies, and both in 5 studies. Of the 32 total studies, 16 used validated survey tools. The most commonly used PROM was the lymph quality of life measure for limb lymphedema (LYMQOL) (12 studies). In the remaining four studies, the upper limb lymphedema 27 scale (ULL27), the short form 36 questionnaire (SF-36), the lymphedema functioning, disability and health questionnaire (Lymph-ICF), and lymphedema life impact scale (LLIS) were each used once. QOL improvement following surgical treatment was noted in all studies. Conclusions: Physiologic surgical treatment of lymphedema results in improved QOL outcomes in most patients. The use of validated PROM tools is increasing but there is no current consensus on use. Future research to evaluate the psychometric properties of PROMs in lymphedema is needed to guide the development and use of lymphedema-specific tools.

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Section: Lymqolmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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“…The other studies did use validated tools to asses QoL. However, these are studies with small sample sizes (range 10–74 patients) and relatively short follow-up (range 6–12 months) [ 10 , 22 , 23 , 33 – 35 ]. To the best of our knowledge, the current study may cover the largest population with the longest follow-up, assessing QoL improvement over different periods of time.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

Qiu

Pruimboom

Cornelissen

et al. 2020

Breast Cancer Res Treat

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Purpose Lymphedema is a debilitating condition that significantly affects patient’s quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. Methods A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. Results One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. Conclusions LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.

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“…20,27–29 However, preoperative detection of lymphatic vessels using ICG lymphography was difficult in most of late-stage UEL patients, because linear patterns were usually concealed by stardust patterns or diffuse patterns in progressive lymphedema. 22–24,26,29–32 Furthermore, ICG lymphography has limitations in detecting lymphatic vessels real-timely, because strong light of an operating microscope and stardust patterns around the incision sites usually influences delicate ICG fluorescent imaging. In this study, real-time ICG videolymphography under operating microscope light could detect 20 lymphatic vessels for LVAs from 24 stardust or diffuse pattern incision sites intraoperatively (83.3% detection rate).…”

Section: Discussionmentioning

confidence: 99%

“…Lymphatic vessels at the arm in UEL patients are relatively small in diameter than that of lower extremity lymphedema patients. 9–14,20,26,32 When lymphatic vessels are under 0.30 mm in diameter, it is not easy to detect lymphatic vessels from connective tissue fibers or nerves in lymphedematous fibrotic subcutaneous tissues even for experts. With our real-time ICG videolymphography, lymphatic vessels were easily detected from these structures.…”

Section: Discussionmentioning

confidence: 99%

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Seki

Kajikawa

Yamamoto

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary: Indocyanine green (ICG) lymphography is a useful imaging modality for evaluation of lymphedema and detection of lymphatic vessels. It also allows us to ensure patency of the anastomosed vessels intraoperatively. However, strong light from the operating microscope usually disturbs ICG fluorescence imaging. Only some built-in ICG camera systems with specific operating microscopes make real-time ICG lymphography possible in lymphaticovenular anastomosis (LVA). We applied a new high-resolution ICG videolymphography system, which is separated from the operating microscope. Because the system can divide near-infrared fluorescence light of ICG from visible light of the operating microscope, real-time ICG videolymphography-navigated LVA under operating microscope illumination is possible regardless types of operating microscopes. The study involved 10 patients with upper extremity lymphedema characterized by International Society of Lymphology stage 2 and treated by 3 lymphaticovenular anastomoses at the forearm (30 lymphaticovenular anastomoses incorporating 30 lymphatic vessels) under real-time ICG videolymphography. The rate of intraoperative detection of lymphatic vessels using real-time ICG videolymphography was 86.7% (0.25–0.85 mm in diameter), and that of lymph flow through the lymphaticovenular anastomoses was 76.7%. None of lymphatic vessels and no flow were detected under the microscope light by means of another non-built-in ICG lymphography camera. Real-time ICG videolymphography in LVA is beneficial, because the surgeon could find lymphatic vessels easily by checking dual images of original view and ICG fluorescent view and ensure accuracy of the LVA in a suture by a suture without any pauses of the surgical procedures.

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Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb

Abstract: This technique allowed to preoperatively map UL lymphatics even if diffuse DB was present.

Cited by 37 publications

References 23 publications

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

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