The Surgical Treatment of Chronic Lymphoedema of the Extremities

Breast cancer-related upper extremity lymphedema is an unsolved iatrogenic complication with a reported incidence ranging from 9 to 41 percent. The increase in volume and recurrent cellulitis of the affected limb cause both physical and mental distress to many breast cancer survivors. However, postmastectomy lymphedema has received little attention, and no curative treatment is available. Conservative treatment with decongestive therapy has been the primary choice for lymphedema treatment, but it is cumbersome and has limited benefits. To date, there is no consensus on surgical procedure and protocol. However, refinements in microsurgical techniques and improved examination devices may lead to the establishment of a standard surgical treatment for lymphedema. This review of surgical procedures for the treatment of postmastectomy lymphedema focuses on microsurgical lymphovenous shunt operations and discusses current issues in surgical treatment and the need for uniform treatment standards.

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“…3). 24,25 This operation was also designed to create a lymphatic bridge between the superficial and deep lymphatic systems.…”

Section: Ablative Operationsmentioning

confidence: 99%

Overview of Surgical Treatments for Breast Cancer–Related Lymphedema

Suami

Chang

2010

Plastic and Reconstructive Surgery

142

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“…44 Sistrunk (1927) and later Thompson applied similar techniques for the treatment of upper extremity lymphedema resulting from breast cancer. 45,46 In these procedures, an elliptical skin and soft tissue excision of the upper extremity is performed in the medial aspect of the arm, and dermal flaps linking the skin and underlying fascia are created in attempt to foster drainage of superficial lymph channels by the deep collecting system. No prospective or long-term studies have been performed to evaluate the outcomes of these studies, although some authors have reported favorable results.…”

Section: Direct Excisionmentioning

confidence: 99%

Surgical Management of Lymphedema: Past, Present, and Future

Mehrara

Zampell

Suami

et al. 2011

Lymphatic Research and Biology

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Recent advances in surgical management of lymphedema have provided options for patients who have failed conservative management with manual lymphatic massage and/or compression garments. The purpose of this review is to provide a historical background to the surgical treatment of lymphedema and how these options have evolved over time. In addition, we aim to delineate the various types of surgical approaches available, indications for surgery, and reported outcomes. Our goal is to increase awareness of these options and foster research to improve their outcomes.

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“…Untreated edema, through its phases of keratosis and fibrosis, may lead to fixed elephantiasis, paralysis of the limb, and even to the development of a sarcoma of the lymphatic organs (McGuire, 1990;O'Domel et al, 1999;Savege, 1985;Staps et al, 1985;Tadych and Domegan, 1987;Thompson, 1967). Among the causes of LUL are hindering of the lymphatic drainage provoked by the extensive ablation of the lymphatic system, scarring or infection of a wound, and recurrence and metastases of a neoplasm (Tadych and Domegan, 1987;Thompson, 1967). Casley-Smith and CasleySmith (1996) add that the formation of LUL is influenced by increased tissue hydrostatic pressure, dilution of proteins in tissue fluid, increased lymphatic transport, and increased proteolysis.…”

Section: Discussionmentioning

confidence: 99%

Influence of some anthropometric parameters on the risk of development of distal complications after mastectomy carried out because of breast carcinoma

Kopański

Wojewoda

et al. 2003

American J Hum Biol

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The analysis included 46 women after radical breast amputation because of cancer with which lymphoedema occurred in the upper limb, as well as 51 women in whom no lymphoedema occurred during the period of the observation. Both groups were subjected to a comparative analysis as for height, body mass, and weight-height indexes: BMI, Quetelet, Rohrer, and Pignet-Verwaeck. The results show that women with high body mass, obesity (BMI > 30.0), and high values of the Quetelet (>370), Rohrer (>1.59), and Pignet-Verwaeck (>93.1) indexes are threatened to a significant degree with lymphoedema of the upper limbs after cancer-related mastectomy. On the other hand, slim body build and low index values appear to be a factor protecting from the occurrence of lymphoedema of the upper limb.

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The Surgical Treatment of Chronic Lymphoedema of the Extremities

Cited by 100 publications

References 97 publications

Overview of Surgical Treatments for Breast Cancer–Related Lymphedema

Overview of Surgical Treatments for Breast Cancer–Related Lymphedema

Surgical Management of Lymphedema: Past, Present, and Future

Influence of some anthropometric parameters on the risk of development of distal complications after mastectomy carried out because of breast carcinoma

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