Microsurgery for management of primary and secondary lymphedema

Drobot, Assi; Bez, Maxim; Shakra, Ibrahim Abu; Merei, Fahed; Kamal, Khatib; Bickel, Amitai; Ganam, Samer; Bogouslavski, Grigori; Karra, Nour; Badran, Mahran; Kassis, Walid; Kogan, Leonid; Drobot, Denis; Weiß, Michael; Koshima, Isao; Kakiashvili, Eli

doi:10.1016/j.jvsv.2020.04.025

Cited by 21 publications

(22 citation statements)

References 19 publications

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“…19 One study used both lymphoscintigraphy and ICG lymphangiography as preoperative imaging in all patients. 13 Our group advocates for the use of lymphoscintigraphy in all cases of patients with primary lymphedema, and we recommend ICG lymphangiography in all patients selected for surgical intervention. Once a diagnosis of primary lymphedema has been made and conservative therapies have reached a therapeutic plateau, the next decision is whether to pursue surgical intervention, and if so, which technique.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Microsurgical Treatment of Primary Lymphedema

Fallahian¹,

Tadisina

2021

Ann Plast Surg

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Introduction: Treatment of lymphedema remains a challenging clinical problem. Lymphatic surgery has recently gained momentum as an effective method to treat both early-and late-stage disease. In particular, "physiologic" microsurgical techniques including vascularized lymph node transplant and lymphovenous bypass/anastomosis have been shown to be effective in treating even advanced lymphedema. Most published reports describe techniques and success in secondary lymphedema. Traditionally, physiologic surgery was not believed to be useful in the treatment of primary lymphedema where baseline lymphatic function is abnormal. However, recent studies have shown a benefit in these cases. The objective of this study is to evaluate outcomes and complications of physiologic microsurgical treatment for primary lymphedema. Methods: The electronic databases of PubMed, Scopus, and MEDLINE were searched using key words "primary lymphedema" and "surgery" (also vascularized lymph node transplant, lymphovenous bypass, microsurgery). Only human studies published between 2000 and 2021 were included. Studies that only included ablative or resection surgeries were excluded. Results: A total of 10 studies comprising 254 patients with primary lymphedema who underwent 357 physiologic microsurgical operations were included. Lymphovenous bypass comprised 88% of cases, and in the patients who underwent vascularized lymph node transplant, all but 1 flap survived. Regardless of type of operative intervention, all studies showed a statistically significant improvement in lymphedema, through either reduction in limb circumference or edema volume or improvement in quality of life. Discussion: Physiologic lymphatic surgery has shown success and improvement for patients with primary lymphedema. Based on current literature, physiologic surgical treatment of primary lymphedema should be considered when treating this patient population.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Microsurgical Treatment of Primary Lymphedema

Fallahian¹,

Tadisina

2021

Ann Plast Surg

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“…where Vs is the volume of a segment, L ¼ length of each segment, and Ct and Cb represent the circumference at the top and the base of the segment, respectively. [18][19][20][21] Volume reduction was defined as a relative decrease in the volume difference between the healthy and affected extremity.…”

Section: Discussionmentioning

confidence: 99%

Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach

Winaikosol

Surakunprapha

2022

Arch Plast Surg

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Background Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping. Methods A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses. Result The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery. Conclusions The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.

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“…The supermicrosurgery technique is an additional tool we would like to add to the treatment option of axillary lymph node dissection (ALND)-related chyle leakage. This technique is already widely used for creating LVA in a minimally invasive surgery for effectively treating limb lymphedema [22,23] . Another application is the creation of LVA in the groin for the reduction of flow and pressure in central lymphatic structures (thoracic duct) for the treatment of lymphatic pleural effusion or ascites in infants with generalized lymphatic dysplasia [24] .…”

Section: Discussionmentioning

confidence: 99%

Lymphaticovenular-anastomosis treatment of the peripheral component in chyle leakage after axillary surgery: case report and review

Drobot¹,

Drobot²,

Sagi³

et al. 2021

PAR

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Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of < 0.7%. The morbidity could be high, and the management prolonged and not clear. The literature offers us many therapeutical tools, yet there is no consensus about the management of this complication. Usually, the management focuses on reducing the chyle flow in the thoracic duct (central origin), neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels (peripheral origin), which causes a prolonged approach with high morbidity. In this paper, we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage. To decrease morbidity and shorten treatment duration, we offer a therapeutic algorithm based on the literature and our experience.

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Microsurgery for management of primary and secondary lymphedema

Cited by 21 publications

References 19 publications

Efficacy of Microsurgical Treatment of Primary Lymphedema

Efficacy of Microsurgical Treatment of Primary Lymphedema

Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach

Lymphaticovenular-anastomosis treatment of the peripheral component in chyle leakage after axillary surgery: case report and review

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