LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema

Boccardo, Francesco; Valenzano, Mario; Costantini, Sergio; Casabona, Federico; Morotti, Matteo; Sala, Paolo; Cian, Franco De; Molinari, L; Spinaci, Stefano; Dessalvi, Sara; Campisi, C.; Villa, Giuseppe; Campisi, Corradino

doi:10.1245/s10434-016-5282-4

Cited by 67 publications

(49 citation statements)

References 24 publications

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“…Concerning the time to perform the anastomoses, the mean duration was comparable with those reported by Onda et al 13 (49.8 minutes vs 42.2 minutes; Table 1), but compared with LVA, even if the MLVA is ideally easier to perform, it presents some technical challenges such as the disparity of caliber between the lymphatics and the iliolumbar vein. In two cases over ten, indeed, after the insertion of the lymphatics, the right lumbar vein's diameter was reduced with an additional stitch.…”

Section: Discussionsupporting

confidence: 78%

“…This is the reason why over the last decades the rat has been a reliable training model to train residents in microsurgery. Yamamoto et al described a supermicrosurgical LVA model in rats performing the exercise on the hind limbs’ LVs, while Onoda et al reported an LVA model involving the use of lumbar lymphatic ducts and iliolumbar veins of rats …”

Section: Discussionmentioning

confidence: 99%

“…Multiple lymphatic‐venous anastomoses (MLVA) have also been recognized as an efficient technique for the surgical prevention and treatment of peripheral lymphedema. This technique, first described by Campisi et al, consisted in performing the MLVA in the proximal limb using the relatively deep and large lymphatics, preserving and telescoping the perilymphatic areolar tissues into the vein along with the lymphatic vessels (LVs). The “octopus” technique proposed by Chen et al modified the previous one selecting superficial and smaller LVs (<0.5 mm), which are skeletonizated to create a more secured anastomosis and performing several incisions to multiply the number of MLVAs.…”

Section: Introductionmentioning

confidence: 99%

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Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Leuzzi

Maruccia

Annoscia

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. Lymphaticovenular anastomoses (LVA) and multiple lymphatic‐venous anastomoses (MLVAs) have been recognized as efficient methods to treat chronic lymphedema. Because few models for lymphatics microsurgical training have been described, the aim of this study is to present a new training model for MLVA in a rat. Methods Ten norvegicus rats were used for this study. After a longitudinal xifo‐pubic incision, lumbar nodes were injected with blue patent violet (BPV) to identify from two to four lymphatic vessels (LVs). MLVAs were carried out inserting lymphatics into the right lumbar vein. Results The mean weight of the rats was 511.4 g. The average diameter of the abdominal LVs used for MLVA was 0.26 mm, and the mean size of the right lumbar vein was 0.84 mm. The average time to perform MLVA was 49.8 minutes. Anastomosis patency rate was 70% based on the passage of BPV from the lymphatics into the vein. Conclusions The rat is still a feasible resource to train microsurgeons, and the MLVA model proposed is simple and reliable and could be very useful for microsurgeon training.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Leuzzi

Maruccia

Annoscia

et al. 2018

Journal of Surgical Oncology

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“…As it was not in the scope of this systematic review, no conclusion can be made if LVA is effective and safe as a prevention treatment for secondary lymphoedema. Nevertheless, LVA may have a role in prevention of lymphoedema (Boccardo et al, 2016;Gomberawalla et al, 2017;Szolnoky, Dobozy, & Kemeny, 2014). Jorgensen et al performed a systematic review on the effect of prophylactic LVA and concluded that due to the heterogeneity between studies, the treatment could not be concluded effective and pointed out that there is a need for high quality studies on this topic (Jorgensen, Toyserkani, & Sorensen, 2017).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Rosian

Stanak

2019

Microsurgery

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IntroductionLymphoedema is a chronic, debilitating condition caused by an affected lymphatic system. Supermicrosurgical techniques like lymphovenous anastomosis (LVA) have gained popularity because of its minimal invasiveness, better aesthetic outcome, and lower costs in comparison to physical medicine. This systematic review aims to evaluate the clinical effectiveness and safety of LVA in comparison to conservative or other surgical treatments for primary or secondary lymphoedema patients.Materials and MethodsA systematic literature search was performed in four databases in December 2017. We applied a methodological framework based on the HTA Core Model®. According to the grading of recommendations, assessment, development, and evaluation (GRADE) scheme, we synthesized the data on each selected outcome category. The studies were systematically assessed for risk of bias (RoB) using the Risk of Bias Assessment tool for Non‐randomized controlled studies (RoBANS) and the Institute of Health Economics (IHE) Risk of Bias checklist for case series.ResultsA total of 629 citations were identified and five studies were assessed eligible for final inclusion (one non‐randomized controlled trial and four prospective single‐arm studies). Across the studies, 217 patients were enrolled. All studies showed a moderate to high RoB. The strength of evidence for the effectiveness and safety of LVA is “very low.” Due to the methodological shortcomings of the available evidence, no conclusions can be made about the effectiveness of the procedure.ConclusionLVA might be a safe technique for patients with primary and secondary lymphoedema—particularly because no serious complications were reported. Furthermore, LVA may have a role in the prevention of lymphoedema.

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“…In addition, researchers have reported that chronic lower extremity venous edema accompanied by varicose veins, lower extremity edema, and pain occurs only as a result of working in a standing posture for eight hours per day2 ) .…”

Section: Introductionmentioning

confidence: 99%

Edema and pain reduction using transcutaneous electrical nerve stimulation treatment

Choi

Lee

2016

J Phys Ther Sci

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[Purpose] The purpose of this study was to investigate the impact on the edema and pain when applying transcutaneous electrical nerve stimulation. [Subjects and Methods] Eleven patients who were diagnosed with lymphedema were selected as the subjects of the study. The experimental group received transcutaneous electrical nerve stimulation treatment on edema regions three times per week for four weeks. Surface tape measurement was used to measure changes in lower extremity edema. Pain intensity was measured using the visual analog scale. [Results] The edema decrements in the experimental group were significantly larger than those in the control group. The pain decrements in the experimental group were significantly larger than those in the control group. [Conclusion] In conclusion, application of transcutaneous electrical nerve stimulation was confirmed to be effective in reducing edema and pain.

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LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema

Abstract: The LYMPHA technique appears to be feasible, safe, and effective for the prevention of lower limb lymphedema, thereby improving the patient's quality of life and decreasing health care costs.

Cited by 67 publications

References 24 publications

Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Lymphatic‐venous anastomosis in a rat model: A novel exercise for microsurgical training

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Edema and pain reduction using transcutaneous electrical nerve stimulation treatment

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