Surgical Treatment of Lymphedema

Abstract

Lymphedema is a complex clinical condition characterized by the malfunction of the lymphatic system responsible for moving tissue fluid from the interstitium into the venous system of the body. This causes retention of tissue fluid in the soft tissues, with associated swelling, inflammation, and destruction of lymphatic channels and chronic pathologic soft-tissue changes.Lymphedema may be caused by genetic or developmental abnormalities (primary lymphedema) or postnatal insults, such as nodal surgery, radiation, and infection (secondary lymphedema). Lymphedema affects 2 to 3 million people in the US alone. Secondary lymphedema affects 1 in 6 survivors of cancer. 1 In the US, breast cancerassociated lymphedema is the most common cause of secondary lymphedema. The reported incidence of lymphedema after sentinel lymph node biopsy is 0% to 23%, while that for axillary lymph node dissection is 11% to 57%. 2 Patients who undergo postoperative radiation are at increased risk.Patients with cancer-associated lymphedema typically present 6 months to 3 years after cancer treatment. Eighty percent of lymphedema onset occurs within the first 3 years of cancer treatment, and the incidence increases by 1% each year. Common symptoms and signs include limb swelling, skin tightness, heaviness, and infections (eg, cellulitis).

Nanofibrillar collagen scaffolds for lymphedema treatment: current applications and future directions

“…Nanofibrillar collagen scaffolds have been used alone and in combination with other therapies. When implanted at the time of vascularized lymph node transfer, for instance, nanofibrillar collagen scaffolds have been shown to accelerate the engraftment of lymphatic tissue by increasing endothelial cell migration and formation of lymphatic vasculature [25][26][27] . Lymph node transfer is thought to stimulate lymphangiogenesis in the surrounding tissue, and the scaffold augments this process by providing soft tissue support for the directional growth of lymphatic channels, as previously described [28] .…”

“…Ultimately, nanofibrillar collagen scaffolds have been demonstrated to stimulate lymphangiogenesis when used alone, in combination with cell-based therapy, and in combination with lymph node fragment transfer or physiologic procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer. Furthermore, the use of BioBridge offers patients an adjunct procedure that can enhance results beyond a physiologic procedure alone, even in late-stage secondary lymphedema, without incurring additional donor site morbidity as would an additional lymph node transfer [25] . Overall, while the specific indications for BioBridge are still under investigation, this technology has demonstrated efficacy across several lymphedema populations (i.e., primary therapy versus secondary therapy after previous physiologic procedure) by helping to improve lymphedema symptoms and engendering targeted, functional lymphangiogenesis.…”

Does Autologous Transfusion Decrease Allogeneic Transfusion in Liposuction Surgery of Lymphedema Patients?

“…Although it is an incurable disease, multiple therapies can help to release the symptom and improve the quality of life. The treatment for lymphedema can be mainly divided into nonsurgical techniques ( 2 ), such as exercise and bandage, and surgical techniques ( 3 ), such as anastomosis. In many cases, the deposited adipose tissue might not be reduced merely through bandaging or anastomosing the lymphatic duct.…”

Introducing JAMA Network Insights in JAMA Dermatology

“…This article type is already available in other JAMA Network journals to provide concise summaries on how to approach common or challenging clinical questions. 1,2 Each JAMA Network Insight article will briefly frame a clinical question, describe relevant pathophysiologic mechanisms, and focus on updates specific to clinical care. These articles will offer expert insights into nuanced clinical scenarios and discuss controversies in the literature, particularly when the clinical evidence base is limited or conflicting.…”

“…An additional aim is to inform readers of key developments in dermatology, including approaches to disease assessment and clinical science. This article type is already available in other JAMA Network journals to provide concise summaries on how to approach common or challenging clinical questions …”