An Effective System of Surgical Treatment of Lymphedema

Granzow, Jay W.; Soderberg, Julie M.; Kaji, Amy H.; Dauphine, Christine

doi:10.1245/s10434-014-3515-y

Cited by 97 publications

(114 citation statements)

References 31 publications

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“…To our knowledge, this is the first comprehensive system to integrate traditional therapy and contemporary surgical techniques in order to address specifically the fluid and solid components of lymphedema. 11 We find that patients whose disease is in the fluid phase are best treated with a physiologic procedure that promotes drainage of fluid from the extremity, such as VLNT or LVA. These patients are usually early in the disease process or may show some improvement with compression garment therapy.…”

Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 94%

“…5). 11 Further reductions have been observed in subsequent years in prospective studies of 145 patients followed over an 8-to 15-year period. 51,52 More significantly, the incidence of dangerous cellulitis is reduced by 75 % or more after the SAPL procedure.…”

Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 97%

“…51,52 More significantly, the incidence of dangerous cellulitis is reduced by 75 % or more after the SAPL procedure. 11,53 During the operation, excess proteinaceous fatty tissue from the affected limb is aspirated using power-assisted liposuction cannulas. The procedure is performed under general anesthesia in the operating room with a surgical tourniquet.…”

Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 99%

“…9,10 This solid phase is characterized by nonpitting edema, with solids representing over 90 % of the excess volume in many chronic lymphedema patients. [11][12][13] The time frame for this transition from fluid to solid can vary considerably between patients.…”

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confidence: 99%

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Review of Current Surgical Treatments for Lymphedema

et al. 2014

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Background. The current mainstay of lymphedema therapy has been conservative nonsurgical treatment. However, surgical options for lymphedema have been reported for over a century. Early surgical procedures were often invasive and disfiguring, and they often had only limited long-term success. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garment use and lymphedema therapy. Microsurgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer lymphaticolymphatic bypass can treat the excess fluid component of lymphedema swelling that presents as pitting edema. Suction-assisted protein lipectomy is a minimally invasive procedure that addresses the solid component of lymphedema swelling that typically occurs later in the disease process and presents as chronic nonpitting lymphedema. These surgical techniques are becoming increasingly popular and their success continues to be documented in the medical literature. We review the efficacy and limitations of these contemporary surgical procedures for lymphedema. Methods. A Medline literature review was performed of lymphedema surgery, vascularized lymph node transfer, lymphaticovenous anastomosis, lymphatic liposuction, and lymphaticolymphatic bypass with particular emphasis on developments within the past 10 years. A literature review of technique, indications, and outcomes of the surgical treatments for lymphedema was undertaken.Results. Surgical treatments have evolved to become less invasive and more effective. Conclusions. With proper diagnosis and the appropriate selection of procedure, surgical techniques can be used to treat lymphedema safely and effectively in many patients when combined with integrated lymphedema therapy.Lymphedema is a progressive and debilitating condition associated with dysfunction of the lymphatic system. While a small percentage of cases are congenital, most patients in developed countries present with lymphedema resulting from treatment of malignancy. The true incidence of lymphedema is difficult to determine as a result of significant differences in diagnostic criteria. However, lymphedema is reported to occur in up to 49 % of breast, 20 % of gynecologic, 16 % of melanoma, 10 % of genitourinary, and 6 % head and neck cancer patients after lymph node dissection and/or radiotherapy. Even among patients who undergo isolated axillary sentinel lymph node biopsy, up to 7 % have measurable arm differences, and up to 10 % have subjective symptoms of lymphedema.

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Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 94%

Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 97%

Section: Suction-assisted Protein Lipectomy (Sapl)mentioning

confidence: 99%

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confidence: 99%

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Review of Current Surgical Treatments for Lymphedema

et al. 2014

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“…Moreover, liposuction is surprisingly effective at preventing lymphedema associated cellulitis. In a series of 10 patients treated for chronic lymphedema with liposuction, incidence of cellulitis decreased from 70% to 10% [28].…”

Section: Suction-assisted Lipectomymentioning

confidence: 97%

Surgical Treatment Modalities for Lymphedema

Lee¹,

DP²,

Bouz³

2016

J Aesthet Reconstr Surg

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Lymphatic channel sheet of polydimethylsiloxane for preventing secondary lymphedema in the rat upper limb model

Cheon

Gelvosa

Kim

et al. 2022

Bioengineering & Transla Med

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Secondary lymphedema is a severe complication of cancer treatment, but there is no effective curative method yet. Lymph node dissection and radiation therapy for cancer treatment may lead to secondary lymphedema, which is a chronic disease induced by malfunction of lymphatic flow. The lymphatic channel sheet (LCS) is an artificial micro‐fluidic structure that was fabricated with polydimethylsiloxane to maintain lymphatic flow and induce lymphangiogenesis. The structure has two‐dimensional multichannels that increase the probability of lymphangiogenesis and allow for relatively easy application. We verified the efficacy of the lymphatic channel sheet through macroscopic and microscopic observation in small animal models, which underwent brachial lymph node dissection and irradiation. The lymphatic channel sheet enabled the successful transport of lymphatic fluid from the distal to the proximal area in place of the removed brachial lymph nodes. It prevented swelling and abnormal lymphatic drainage during the follow‐up period. Lymphangiogenesis was also identified inside the channel by histological analysis after 8 weeks. According to these experimental results, we attest to the roles of the lymphatic channel sheet as a lymphatic pathway and scaffold in the rat upper limb model of secondary lymphedema. The lymphatic channel sheet maintained lymphatic flow after lymph node dissection and irradiation in an environment where lymph flow is cut off. It also relieved symptoms of secondary lymphedema by providing a lymph‐friendly space and inducing lymphangiogenesis.

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An Effective System of Surgical Treatment of Lymphedema

Cited by 97 publications

References 31 publications

Review of Current Surgical Treatments for Lymphedema

Review of Current Surgical Treatments for Lymphedema

Surgical Treatment Modalities for Lymphedema

Lymphatic channel sheet of polydimethylsiloxane for preventing secondary lymphedema in the rat upper limb model

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