Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama.

Abstract

Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with -deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). Results: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. Conclusion: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning. MontagInfluence of vascularized lymph node transfer (VLNT) flap positioning on the response to breast cancer-related lymphedema treatment.

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

“…18 Nguyen et al performed meticulous debulking of upper extremity recipient site tissue, with 90% of their patients reporting improvements in lymphedema-related symptoms and recipient-site complications limited to hematomas and seromas. 27,28 An additional advantage of VOLT is that the abundance of lymphatic tissue in the omentum allows for the division of a single flap into two smaller flaps, making double VOLT a promising option. 19,22 Double VOLT, with a combination distal and middle or proximal and middle inset, was utilized by several authors to take advantage of benefits of each site.…”

“…However, Montag et al found no difference in volume reduction between the proximal and distal insets. 27 , 28 Proximal inset is advantageous in that it allows for the release of postsurgical/radiation scar tissue within the axilla, and also potentially allow for decompression of the axillary vein. However, the presence of such scar tissue may complicate lymphatic transplant.…”

Gastroepiploic vascularized lymph node transfer for the treatment of extremity lymphedema: comparison between middle and distal inset

“…There is no consensus on the best recipient site for lymph node flap transfer. Some authors argue that a distal inset (wrist or ankle) is desirable in cases of advanced lymphedema, where ascending lymph flow is greatly impaired and lymphatic flow pools with the action of gravity (35). Moreover, distal recipient sites are typically healthy and without radiation damage, whereas proximal sites (axilla or groin) are usually severely scarred due to radiation or prior surgical incisions.…”

A systematic review and meta-analysis of vascularized lymph node transfer for breast cancer-related lymphedema

“…However, only eight studies reported outcomes of both the healthy and affected extremity, or the decrease in extremity differences compared to the difference prior to surgery. (15,(24)(25)(26)(27)(28)(29)(30) These eight studies were analysed and the results are demonstrated in a forest plot (Figure 2). The mean reduction of the volume difference between the healthy and affected extremities was 40.31% (CI 31.44-49.17).…”