Treatment of end-stage lymphedema following radiotherapy for lymphoma

Abstract

Rationale : Despite significant advances in microsurgical techniques, simultaneous vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of end-stage lymphedema. This case report describes the successful treatment of end-stage lymphedema with VLNT and LVA. Patient Concerns: A 72-year-old patient with bilateral lower extremity lymphedema was referred to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. Diagnosis: According to the indocyanine green lymphography, lymphoscintigraphy, and magnetic resonance lymphangiography, the patient was diagnosed with end-stage lymphedema (International Society of Lymphology stage 3). Intervention: The patient underwent simultaneous VLNT and LVA for treatment of end-stage lymphedema. Outcomes: Significant reduction in circumference and volume of lower extremity was achieved following simultaneous VLNT and LVA Lessons: Simultaneous VLNT and LVA surgeries may be effective in patients with end-stage lymphedema.

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb

“…Furthermore, Agko et al, 45 in a prospective study for patients with advanced-stage II lymphedema, showed that a staged surgical approach involving VLNT followed by suction-assisted lipectomy resulted in a significant reduction in limb size, nearly restoring it to normal levels, and effectively eliminated instances of infections. In our systematic review and meta-analysis, most of included studies reporting lymphedema stage included advanced stages such as stage II and III, this is with alignment that VLNT alone can demonstrate satisfactory enhancement in individuals with advanced-stage lymphedema, while LVA is thought of in early stage, such as stage I lymphedema 46 …”

“…In our systematic review and meta-analysis, most of included studies reporting lymphedema stage included advanced stages such as stage II and III, this is with alignment that VLNT alone can demonstrate satisfactory enhancement in individuals with advancedstage lymphedema, while LVA is thought of in early stage, such as stage I lymphedema. 46 Limitations and Future Prospective…”