Lymph node grafting in the treatment of upper limb lymphoedema: a clinical trial

Travis, Elizabeth C.; Shugg, Sarah; McEwan, Winston

doi:10.1111/ans.13171

Cited by 12 publications

(12 citation statements)

References 15 publications

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“…35,41 The 12 high-quality LVA studies had a mean AE SD MINORS score of 13.9 AE 1.2. [42][43][44][45] Thus, only patients with persistent swelling received VLNT. Seven studies reported complications of VLNT procedures.…”

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

“…Seven studies reported complications of VLNT procedures. [42][43][44][45][46][47][48] The most common complications were cellulitis, lymphocele, and donor site pain, seroma, and lymphedema. Other complications included hematoma, wound dehiscence, wound infection, hydrocele, partial skin graft loss, and venous congestion.…”

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

“…Additional interventions were used postoperatively in eight of the studies. Four suggested compression garments, 43,44,46,49 four encouraged CDT or physiotherapy, 42,44,47,50 and two also recommended lymphatic drainage. 46,49 Four studies reported QoL outcomes showing improved function, appearance, and mood along with decreased pain.…”

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

“…46,49 Four studies reported QoL outcomes showing improved function, appearance, and mood along with decreased pain. 43,45,50,51 The 10 high-quality VLNT studies had a mean AE SD MINORS score of 14.1 AE 0.9.…”

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

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Systematic Review of the Surgical Treatment of Extremity Lymphedema

Carl

Walia

Bello

et al. 2017

J reconstr Microsurg

146

120

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Although conservative management of lymphedema remains the first-line approach, surgery is effective in select patients. The purpose of this study was to review the literature and develop a treatment algorithm based on the highest quality lymphedema research. A systematic literature review was performed to examine the surgical treatments for lymphedema. Studies were categorized into five groups describing excision, liposuction, lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and combined/multiple approaches. Studies were scored for methodological quality using the methodological index for nonrandomized studies (MINORS) scoring system. A total of 69 articles met inclusion criteria and were assigned MINORS scores with a maximum score of 16 or 24 for noncomparative or comparative studies, respectively. The average MINORS scores using noncomparative criteria were 12.1 for excision, 13.2 for liposuction, 12.6 for LVA, 13.1 for VLNT, and 13.5 for combined/multiple approaches. Loss to follow-up was the most common cause of low scores. Thirty-nine studies scoring > 12/16 or > 19/24 were considered high quality. In studies measuring excess volume reduction, the mean reduction was 96.6% (95% confidence interval [CI]: 86.2-107%) for liposuction, 33.1% (95% CI: 14.4-51.9%) for LVA, and 26.4% (95% CI: - 7.98 to 60.8%) for VLNT. Included excision articles did not report excess volume reduction. Although the overall quality of lymphedema literature is fair, the MINORS scoring system is an effective method to isolate high-quality studies. These studies were used to develop an evidence-based algorithm to guide clinical practice. Further studies with a particular focus on patient follow-up will improve the validity of lymphedema surgery research.

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Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

Section: Lymphatic Reconstructive Proceduresmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review of the Surgical Treatment of Extremity Lymphedema

Carl

Walia

Bello

et al. 2017

J reconstr Microsurg

146

120

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“…In this edition of the journal, Travis et al have added another procedure to this mix in the form of lymph node grafting. 1 In a small number of cases, they have reported the transfer of lymph nodes into lymphoedematous limbs without microanastomosis of the feeding vessels. Preliminary evidence indicates reduction in limb volumes and some restoration of lymphatic flow.…”

mentioning

confidence: 99%

Surgical challenge of lymphoedema

Penington

2015

ANZ Journal of Surgery

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Vascularized lymph node transplantation successfully reverses lymphedema and maintains immunity in a rat lymphedema model

Sakarya

Huang

Yang

et al. 2022

Bioengineering & Transla Med

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Vascularized lymph node transplantation (VLNT) has shown inspiring results for the treatment of lymphedema. Nevertheless, it remains unclear how VLNT restores lymphatic drainage and whether or not immunity recovers after surgery. Hindlimb lymphedema model was created using rats with extensive groin and popliteal lymph node removable following with radiotherapy, and the lymphedema was confirmed using indocyanine green (ICG) lymphangiography and micro-computer tomography for volume measurement. VLNT was performed 1 month later. Volume measurement, ICG lymphangiography, histology, and immune reaction were done 1 month after surgery. VLNT successfully reduced the volume of the lymphedema hindlimb, restored lymphatic drainage function with proven lymphatic channel, and reduced lymphedema-related inflammation and fibrosis. It promotes lymphangiogenesis shown from ICG lymphangiography, histology, and enhanced lymphangiogenesis gene expression. Dendritic cell trafficking via the regenerated lymphatic channels was successfully restored, and maintained systemic immune response was proved using dinitrofluorobenzene sensitization and challenge. VLNT effectively reduces lymphedema and promotes lymphatic regeneration in the capillary lymphatic but not the collecting lymphatic vessels. Along with the re-established lymphatic system was the restoration of immune function locally and systemically. This correlated to clinical experience regarding the reduction of swelling and infection episodes after VLNT in lymphedema patients.

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Lymph node grafting in the treatment of upper limb lymphoedema: a clinical trial

Abstract: We conclude that this is a safe procedure and should be further investigated as an alternative to a microsurgical procedure as a treatment for upper limb lymphoedema. Further research with a larger sample size is needed to confirm the findings of this pilot study.

Cited by 12 publications

References 15 publications

Systematic Review of the Surgical Treatment of Extremity Lymphedema

Systematic Review of the Surgical Treatment of Extremity Lymphedema

Surgical challenge of lymphoedema

Vascularized lymph node transplantation successfully reverses lymphedema and maintains immunity in a rat lymphedema model

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