A chimeric vascularised groin lymph node flap and DIEP flap for the management of lymphoedema secondary to breast cancer

Dancey, Anne; Nassimizadeh, Abdul; Nassimizadeh, Mohammad; Warner, Richard C.; Waters, Ruth

doi:10.1016/j.bjps.2012.12.010

Cited by 35 publications

(33 citation statements)

References 4 publications

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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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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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“…In cases where VLNT alone is performed, the superficial circumflex iliac vessels are anastomosed to recipient vessels. 3,15,17 If breast reconstruction with VLNT is desired, the deep inferior epigastric vessels are used, 10,18 with the additional option of anastomosing the superficial circumflex iliac vessels or the superficial inferior epigastric vessels to maintain lymph node vascularity. 18,23 A novel technique has been described by Gharb These vessels, usually originating from the superficial branch of the superficial circumflex iliac and superficial inferior epigastric vessels, are traced in a retrograde fashion while simultaneously visualizing supplied lymph nodes.…”

Section: Donor Site Groinmentioning

confidence: 99%

“…1,3,15,16,21 However, one main concern with harvesting lymph nodes from the groin or the axilla is a possibility of causing donor site lymphedema. 17,18 The use of preoperative lymphoscintigraphy, combined with the use of intraoperative gamma probe detection to detect "sentinel" lymph nodes that have Copyright © 2014 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.…”

Section: Comparison Of Flapsmentioning

confidence: 99%

“…3,18,23 "Suction" is then continued by large, superficial, and low-pressure venous system. 3,18,23 Because lymph itself has a lower colloid osmotic pressure than blood, lymphatic fluid is drawn into capillaries. 17 Therefore, transplanted lymph nodes must have an adequate blood supply to maintain Starling forces, reestablish afferent and efferent lymphatic connections, and survive with minimal atrophy.…”

Section: Theoretical Mechanism Of Vlnt "Pumping" Actionmentioning

confidence: 99%

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Vascularized Lymph Node Transfer for Treatment of Lymphedema

2015

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“…After BCRL, chimeric flaps involving the DIEP flap and vascularized groin LNT are an effective and complete therapeutic option for the management of this condition [8]. …”

Section: Discussionmentioning

confidence: 99%

First Report of Pyoderma Gangrenosum after Surgery of Breast Cancer-Related Lymphedema with Transfer of Vascularized Free Lymph Nodes of the Groin and Simultaneous DIEP Flap

2016

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Background: Pyoderma gangrenosum (PG) is a rare cutaneous ulcerative disease that does not respond to antibiotics and worsens with surgical manipulation. This is the first report in the literature revealing that this disease complicates total microsurgical breast reconstruction associated with the transfer of free lymph nodes. Case Report: We report the case of a female patient who underwent left-breast microsurgical reconstruction with a deep inferior epigastric perforator (DIEP) flap and simultaneous transfer of vascularized free lymph nodes for the surgical treatment of secondary left upper-limb lymphedema, and who developed a severe PG of both the skin of the flap and the donor zone on postoperative day 7. After exclusion of other etiologies, treatment with high-dose corticosteroids and topical zinc sulfate was initiated. The flap was salvaged and breast cancer-related lymphedema (BCRL) surgery was definitively effective despite the PG. Conclusions: PG should be considered in the differential diagnosis of progressive cutaneous ulcers following surgical interventions, once infectious and ischemic etiologies have been excluded. Early initiation of immunosuppressive treatment can lead to preservation of the initial flap and function of the transferred lymph nodes in the case of microsurgical breast reconstruction with associated lymph node transfer.

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A chimeric vascularised groin lymph node flap and DIEP flap for the management of lymphoedema secondary to breast cancer

Cited by 35 publications

References 4 publications

Anti-inflammatory effects of flap and lymph node transfer

Anti-inflammatory effects of flap and lymph node transfer

Vascularized Lymph Node Transfer for Treatment of Lymphedema

First Report of Pyoderma Gangrenosum after Surgery of Breast Cancer-Related Lymphedema with Transfer of Vascularized Free Lymph Nodes of the Groin and Simultaneous DIEP Flap

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