Pathological changes in the lymphatic system of patients with secondary upper limb lymphoedema

Abstract

Secondary upper limb lymphoedema is usually caused by lymphatic system dysfunction. Diagnosis is primarily based on clinical features. However, there are no distinct diagnostic criteria for lymphoedema. Although conventional lymphoscintigraphy is a useful technique to diagnose the severity of lymphoedema, the resultant data are two-dimensional. In this study, we examined the pathology of lymphoedema using single photon emission computed tomography-computed tomography lymphoscintigraphy (SPECT-CT LSG), a new technique that provides 3-dimensional information on lymph flow. We observed lymph flow pathways in the subcutaneous and muscle layers of the upper limbs. A significant positive correlation was found between the dermal back flow (DBF) type and the visualization of lymph nodes around the clavicle ( p = 0.000266), the type of lymph flow pathways and the visualization of lymph nodes around the clavicle ( p = 0.00963), and the DBF type and the lymph flow pathway (p = 0.00766). As the severity of lymphoedema increased, the DBF appeared more distally in the upper limb and the flow into the lymph nodes around the clavicle decreased, whereas the lymph flow pathways in the muscle layer became dominant. These findings demonstrate the features of lymphoedema pathology and the functional anatomy and physiology of the lymphatic system without the need for cadaver dissection.

Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments

“…Some centers have reported also quantitative analysis based on decay-adjusted uptake and lymphatic transport index; however these are not commonly performed [ 39 , 40 ]. Recently, single photon emission computed tomography-computed tomography (SPECT-CT) lymphoscintigraphy has been used for the diagnosis of lymphedema providing 3-D live images of lymph flow [ 38 , 41 , 42 ]. A recent study reported significant association between the type of dermal backflow, the lymph flow pathways, and the visualization of lymph nodes around the clavicle [ 42 ].…”

Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images

“…suggesting that the superficial lymph flow pathways, the channels in the subcutaneous layer, were the main stream to the clavicular lymph nodes. 12 Similar mechanisms in the lymph flow pathways and lymph nodes in the inguinal region and relationship with DBF type are suspected among patients with secondary lower limb lymphedema. 12,13 We aimed to verify this hypothesis and confirm the lymph flow pathways under the deep fascia.…”

Skin Oncoplasties: Is Z-Plasty A Technique of Choice In Situation of Limited Resources? Case of Burkina Faso.

“…Secondary healing involves numerous wounds dressings over several months. The mobilisation of fascia-muscle aps requires technical skills and a trained team [7,[10][11][12][13]. Z-plasty, a technique which has being used for long in plastic surgery, is less complex to perform and is therefore an alternative for skin coverage after large tumour resections [11,13,14].…”

“…The mobilisation of fascia-muscle aps requires technical skills and a trained team [7,[10][11][12][13]. Z-plasty, a technique which has being used for long in plastic surgery, is less complex to perform and is therefore an alternative for skin coverage after large tumour resections [11,13,14]. In Burkina Faso, Z-plasty has been used for several years now, following skin cancers large resections [6].…”

“…The lesions are often large and brings the problem of skin coverage after their resections. Several reconstruction techniques allow skin coverage [10,11]. Skin grafts require a good basement and good hygiene conditions.…”