Vascularized Groin Lymph Node Flap Transfer for Postmastectomy Upper Limb Lymphedema

Cheng, Ming‐Huei; Chen, Shin‐Cheh; Henry, Steven L.; Tan, Bien Keem; Lin, Miffy Chia‐Yu; Huang, Jung‐Ju

doi:10.1097/prs.0b013e31828bd3b3

Cited by 300 publications

(282 citation statements)

References 43 publications

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“…The exact mechanism for the effectiveness of VLNT is unclear but is thought to be related to the release of axillary scarring, the reconnection of transplanted and donor site lymphatics, and also a direct pumping/fluid removal of the excess lymph by the transferred lymph nodes. 23 In this series, patients treated for the fluid phase of lymphedema with VLNT had a greater reduction than with LVA in the number of hours of daily garment use and lymphedema therapy required. One explanation for the superior results of VLNT may be that most of the LVA patients were treated for lower extremity lymphedema, whereas VLNT patients all had upper extremity lymphedema.…”

Section: Discussionmentioning

confidence: 91%

An Effective System of Surgical Treatment of Lymphedema

et al. 2014

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Background. Effective surgical treatments for lymphedema now can address the fluid and solid phases of the disease process. Microsurgical procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), target the fluid component that predominates at earlier stages of the disease. Suctionassisted protein lipectomy (SAPL) addresses the solid component that typically presents later as chronic, nonpitting lymphedema of an extremity. We assess the outcomes of patients who underwent selective application of these three surgical procedures as part of an effective system to treat lymphedema. Methods. This is a retrospective chart review of patients with lymphedema who underwent complete decongestive therapy followed by surgical treatment with SAPL, LVA, or VLNT. The primary outcomes measured were postoperative volume reduction (SAPL), daily requirement for compression garments and lymphedema therapy (VLNT and LVA), and the incidence of severe cellulitis. Results. Twenty-six patients were included in the study, of which 10 underwent SAPL and 16 underwent LVA or VLNT. The average reduction of excess volume by SAPL was 3,212 mL in legs and 943 mL in arms, or a volume reduction of 87 and 111 %, respectively, when compared with the unaffected, opposite sides. Microsurgical procedures (VLNT and LVA) significantly reduced the need for both compression garment use (p = 0.003) and lymphedema therapy (p \ 0.0001). The overall rate of cellulitis decreased from 58 % before surgery to 15 % after surgery (p \ 0.0001).Conclusions. When applied appropriately to properly selected patients, surgical procedures used in the treatment of lymphedema are effective and safe.Lymphedema in the developed world commonly occurs after lymph node dissection and/or radiotherapy to nodal basins for breast cancer, melanoma, or gynecologic malignancies. Less commonly, lymphedema occurs as a result of congenital causes.

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Section: Discussionmentioning

confidence: 91%

An Effective System of Surgical Treatment of Lymphedema

et al. 2014

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“…Recently, flap transfer with lymph nodes has been used in the treatment of lymphedema patients [5,6,41,42]. In clinical studies, the LN seems to improve lymphatic flow of the affected arm [5e7].…”

Section: Discussionmentioning

confidence: 99%

Anti-inflammatory effects of flap and lymph node transfer

Viitanen

Visuri

Sulo

et al. 2015

Journal of Surgical Research

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Transfer of healthy tissue hinders the proinflammatory response after surgery, which may explain the beneficial effects of flap transfer in various patient groups. In addition, flap transfer with lymph nodes seems to also promote an antifibrotic effect. The clinical effects of LN in lymphedema patients may be mediated by the increased production of prolymphangiogenic growth factor (VEGF-C) and antifibrotic cytokine (IL-10).

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“…The superficial inguinal lymph nodes are fed by the SCIA, SIEA, and the medial artery [4]. Recent studies have shown that nodes in the inferior-medial and the central areas of the saphenofemoral junction should not be selected as donor sites for VLNT, because they are the primary superficial nodes draining the lower limb [2,3].…”

Section: Discussionmentioning

confidence: 99%