The difference in the caliber of efferent lymphatic vessels among various lymph node flaps

Taranto, Giuseppe Di; Amorosi, Vittoria; Alamouti, Reza; Sitpahul, Ngamcherd; Chan, Jcy; Ly, Liao; Ribuffo, Diego; Hc, Chen

doi:10.1002/jso.25257

Cited by 10 publications

(8 citation statements)

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“…In their work, they found a strong association between the staging classification of lymphedema by ISL and the composition of lymphatic tissues in terms of changes occurring on the histological level of the collective vessels analyzed. They proved that in advanced stages lymphatic vessels become sclerotic, less functional, and this may be the reason for the reduction in the efficacy of the LVA approach (Ciudad, Agko, et al, 2017; Ciudad, Agko, et al, 2019; Di Taranto et al, 2018; Di Taranto et al, 2020; Inserra et al, 2016). According to Cheng, different stages of lymphedema require different treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Today these procedures, which include lymphatic‐venous anastomosis (LVA), vascularized lymph node transfer (VLNT), and lymphatic–lymphatic bypass are becoming increasingly popular (Di Taranto, Elia, Amorosi, et al, 2018; Yamamoto & Koshima, 2015; Yamamoto, Yoshimatsu, & Yamamoto, 2016). Based on the hypothesis that transferred lymph nodes will behave as a new pump helping the deteriorated lymphatic system (Lin et al, 2009), the VLNT consists of the transplantation of lymph node‐containing tissue together with artery and vein from a donor site to the affected limb (Becker, Assouad, Riquet, & Hidden, 2006; Cheng, Huang, Huang, et al, 2012; Saaristo et al, 2012; Viitanen, Mäki, Seppänen, Suominen, & Saaristo, 2012).…”

Section: Introductionmentioning

confidence: 99%

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A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

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Background There is no consensus on the appropriate treatment of lymphedema. Proposed techniques include lymphaticovenous anastomosis (LVA), vascularized lymph nodes transfer (VLNT), and suction lipectomy (SL). The benefit of combined procedures has also been postulated. In this prospective study, a combined protocol is proposed as an alternative to single‐procedure strategies. Methods Between January 2016 and October 2018, we enrolled patients with secondary lymphedema of lower limbs, stage II‐III according to the International Society of Lymphology, progressive swelling and skin tonicity >60. Thirty‐seven consecutive patients were dichotomized into group I, undergoing VLNT, and group II undergoing VLNT and LVA. Gastroepiploic lymphnode flap was harvested through laparoscopy, and in the same operation, LVAs were performed in group II on the basis of indocyanine green lymphography and patent blue findings. Two weeks later, SL was performed in all the patients. Patients were prospectively evaluated through clinical examination, circumference measurement, and skin tonicity. Results The average follow‐up was 2 ± 0.8 years. The first consecutive 21 patients were treated with VLNT followed by SL. The next 16 patients underwent combined VLNT and LVA, followed by SL. A mean of 2.4 LVAs were performed. A significant difference in the postoperative circumference measurements was found overall (p < .05): 52.6 ± 18.9 above the knee, 42.9 ± 25 below the knee, 36.2 ± 37 at foot. The postoperative tonicity dropped by 12.7 ± 6.3% (p < .05). The episodes of cellulitis significantly decreased to 0.1 ± 0.3 (p < .05). Conclusions LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

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“…Covering the RG‐VLN flap with local flaps brings the omentum into an environment that is more similar to the native intraabdominal one in terms of temperature and tissue oxygenation, rather than covering it with a skin graft. We believe that this condition could have a favorable effect on lymph node flap survival and function, in addition to maximize the aesthetic appearance of the transferred flap (Di Taranto et al, ; Maruccia et al, ; Maruccia et al, ). Third, all the patients followed a precise postoperative conservative protocol based on active physiotherapy and compression garments.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…Surgery could overcome these limits by improving the physiological circulation of lymphatic fluid in progressive and resistant lymphedema. A variety of procedures have been proposed in the past decades, but modern accepted surgical techniques for treating lymphedema include liposuction, vascularized lymph node transfer, and lymphovenous anastomosis (LVA) (13)(14)(15)(16)(17)(18). The effectiveness of these procedures has been reported in previous studies, but the literature demonstrates a great heterogeneity in presented outcomes.…”

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Lymphovenous Anastomosis for the Treatment of Lymphedema: A Systematic Review of the Literature and Meta-Analysis

et al. 2021

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Lymphovenous anastomosis (LVA) has been described as an effective treatment for early stages of lymphedema (LE). The aim of this study was to deepen the evaluation of the effectiveness of LVA by performing a meta-analysis to provide information about its utility in specific anatomical sites, clinical stages, duration of lymphedema, and surgical technique. A systematic literature search using PubMed/Medline, Google Scholar, and Cochrane Database was performed in November 2019. Only original studies in which exclusively LVA was performed for primary and/or secondary lymphedema in humans were eligible for data extraction. A meta-analysis was performed on articles with a well-defined endpoint and a subgroup analysis was conducted in relation to surgical technique, duration of lymphedema, stage of pathology. Forty-eight studies, including 6 clinical trials and 42 low-risk bias observational studies were included in our meta-analysis. 1,281 subjects were included and the majority of articles reported a pre-post analysis. Lymphaticovenular anastomosis appears to result effectively in treatment of lymphedema with an odds ratio of 0.07 (CI: 0.04, 0.13, p<0.001). All subgroup meta-analyses were statistically significant for LVAs specifically with regard to anatomical site, clinical stage, duration of LE, or type of microsurgical procedure (p<0.05). Our meta-analysis confirmed the efficacy of LVAs for the treatment of lymphedema, even when subgroup analysis was performed for clinical stage, duration of pathology, anatomical site of lymphedema, or type of microsurgical procedure. Further prospective trials with a common clearly defined outcome measure are warranted for an unbiased evaluation.

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The difference in the caliber of efferent lymphatic vessels among various lymph node flaps

Cited by 10 publications

References 5 publications

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

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

Lymphovenous Anastomosis for the Treatment of Lymphedema: A Systematic Review of the Literature and Meta-Analysis

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