Lymph node transplantation for the treatment of lymphedema

Gould, Daniel J.; Mehrara, Babak J.; Neligan, Peter C.; Cheng, Ming‐Huei; Patel, Ketan M.

doi:10.1002/jso.25180

Cited by 71 publications

(59 citation statements)

References 58 publications

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“…When new channels sprout from the transferred lymph node connected to a peripheral artery and vein functions, it becomes a vascularized lymphaticovenous bypass "relay station." With better understanding of the vascular anatomy of lymph nodes, surgeons are able to safely harvest lymph nodes from the groin, head, and neck region and abdomen for transfer as lymph node flaps (Gould et al, 2018). From clinical observations, it takes about 2 years for new lymphatic channels to form and be functional.…”

Section: Management Of Lymphedema By Multi-modalities Treatmentmentioning

confidence: 99%

The Unresolved Pathophysiology of Lymphedema

et al. 2020

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Lymphedema is the clinical manifestation of impaired lymphatic transport. It remains an under-recognized and under-documented clinical condition that still lacks a cure. Despite the substantial advances in the understanding of lymphatic vessel biology and function in the past two decades, there are still unsolved questions regarding the pathophysiology of lymphedema, especially in humans. As a consequence of impaired lymphatic drainage, proteins and lipids accumulate in the interstitial space, causing the regional tissue to undergo extensive and progressive architectural changes, including adipose tissue deposition and fibrosis. These changes are also associated with inflammation. However, the temporal sequence of these events, the relationship between these events, and their interplay during the progression are not clearly understood. Here, we review our current knowledge on the pathophysiology of lymphedema derived from human and animal studies. We also discuss the possible cellular and molecular mechanisms involved in adipose tissue and collagen accumulation during lymphedema. We suggest that more studies should be dedicated to enhancing our understanding of the human pathophysiology of lymphedema to pave the way for new diagnostic and therapeutic avenues for this condition.

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Section: Management Of Lymphedema By Multi-modalities Treatmentmentioning

confidence: 99%

The Unresolved Pathophysiology of Lymphedema

et al. 2020

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“…Advances in microsurgical techniques and an improved understanding of the pathophysiology of lymphedema have led to the development of a variety of surgical options for the treatment of secondary lymphedema [1][2][3][4][5]. However, although numerous investigators have published outcomes following lymphovenous bypass [6][7][8][9], vascularized lymph node transplantation [2,3,[10][11][12][13][14], and liposuction [5,15], a detailed discussion of the assessment of prospective surgical candidates has not been reported. As a result, there are currently many preoperative assessment protocols complicating comparison of outcomes between centers [16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Assessment of Upper Extremity Secondary Lymphedema

Wiser

Mehrara

Coriddi

et al. 2020

Cancers

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Introduction: The purpose of this study was to evaluate the most commonly used preoperative assessment tools for patients undergoing surgical treatment for secondary upper extremity lymphedema. Methods: This was a prospective cohort study performed at a tertiary cancer center specializing in the treatment of secondary lymphedema. Lymphedema evaluation included limb volume measurements, bio-impedance, indocyanine green lymphography, lymphoscintigraphy, magnetic resonance angiography, lymphedema life impact scale (LLIS) and upper limb lymphedema 27 (ULL-27) questionnaires. Results: 118 patients were evaluated. Limb circumference underestimated lymphedema compared to limb volume. Bioimpedance (L-Dex) scores highly correlated with limb volume excess (r2 = 0.714, p < 0.001). L-Dex scores were highly sensitive and had a high positive predictive value for diagnosing lymphedema in patients with a volume excess of 10% or more. ICG was highly sensitive in identifying lymphedema. Lymphoscintigraphy had an overall low sensitivity and specificity for the diagnosis of lymphedema. MRA was highly sensitive in diagnosing lymphedema and adipose hypertrophy as well as useful in identifying axillary vein obstruction and occult metastasis. Patients with minimal limb volume difference still demonstrated significantly impaired quality of life. Conclusion: Preoperative assessment of lymphedema is complex and requires multimodal assessment. MRA, L-Dex, ICG, and PROMs are all valuable components of preoperative assessment.

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“…Lymphedemas resistant to conservative therapy, pain and chronic infection are the preferred indications for surgical treatment. Lymph node flap transfer has gradually gained popularity for the treatment of both upper and lower limb lymphedema (Althubaiti, Crosby, & Chang, 2013;Azuma, Yamamoto, & Koshima, 2013;Becker, 2016;Chang, Masià, & Smith, 2018;Cheng, Koshima, Chang, & Masia, 2017;Giudice et al, 2017;Gould, Mehrara, Neligan, Cheng, & Patel, 2018;Kung et al, 2017;Lin et al, 2009;Masià, Pons, & Rodríguez-Bauzà, 2016;Patel, Lin, & Cheng, 2015;Schaverien, Badash, Patel, Selber, & Cheng, 2018;Silva & Chang, 2016). Several donor sites for lymph node flaps have been described, including the abdominal area Ciudad, Kiranantawat, Sapountzis, et al, 2015;Ciudad, Manrique, Date, Agko, et al, 2017;Ciudad, Manrique, Date, Sacak, et al, 2017;Di Taranto, Chen, Elia, et al, 2019;Di Taranto, Elia, Amorosi, et al, 2018;Leuzzi et al, 2018;Maruccia et al, 2019).…”

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confidence: 99%

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

et al. 2019

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Background Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG‐VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema. Methods All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG‐VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1 year follow up through LYMQOL questionnaire. Results Sixteen patients met inclusion criteria. Mean follow up was 26.2 months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12 months of follow up, the mean CRR was 58.3% at BK level (p = .001*) and 43.4% at AK level (p < .04*). LYMQOL metrics showed significantly better scores in all domains. Conclusions Patients with lower limb lymphedema can benefit from combined DG‐VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.

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Lymph node transplantation for the treatment of lymphedema

Cited by 71 publications

References 58 publications

The Unresolved Pathophysiology of Lymphedema

The Unresolved Pathophysiology of Lymphedema

Preoperative Assessment of Upper Extremity Secondary Lymphedema

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

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