Vascularized Groin Lymph Node Transfer Using the Wrist as a Recipient Site for Management of Postmastectomy Upper Extremity Lymphedema

Lin, Chih-Hung; Ali, Rozina; Chen, Shin‐Cheh; Wallace, Chris; Chang, Yue; Chen, Hung-Chi; Cheng, Ming‐Huei

doi:10.1097/prs.0b013e31819e6529

Cited by 344 publications

(331 citation statements)

References 26 publications

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“…Direct healing of transplanted lymphatics has been shown to occur in animal models and in vivo in transplanted free flaps and likely accounts for some of the improvements observed and the success found by those using recipient sites such as the wrist or ankle. 34,38,39 The main disadvantage of the VLNT procedure is the potential but unlikely risk for donor site morbidity. Careful selection and collection of lymphatics during the procedure is used to minimize risk of disturbing lymphatics at the donor site.…”

Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

“…Varying donor and recipient sites are used, but most microsurgeons opt to move lymph nodes from the lateral groin to the affected axilla, while others choose to transfer tissue to the wrist or ankle. [30][31][32][33][34][35][36] If simultaneous breast reconstruction is performed, the lymph node flap can be transferred together with a deep inferior epigastric perforator (DIEP) abdominal soft tissue flap. In such cases, a DIEP flap is used instead of a transverse rectus abdominis myocutaneous (TRAM) flap, both to decrease postoperative abdominal morbidity and to allow better geometry of inset for the lymph node flap in the axilla.…”

Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

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Review of Current Surgical Treatments for Lymphedema

et al. 2014

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Background. The current mainstay of lymphedema therapy has been conservative nonsurgical treatment. However, surgical options for lymphedema have been reported for over a century. Early surgical procedures were often invasive and disfiguring, and they often had only limited long-term success. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garment use and lymphedema therapy. Microsurgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer lymphaticolymphatic bypass can treat the excess fluid component of lymphedema swelling that presents as pitting edema. Suction-assisted protein lipectomy is a minimally invasive procedure that addresses the solid component of lymphedema swelling that typically occurs later in the disease process and presents as chronic nonpitting lymphedema. These surgical techniques are becoming increasingly popular and their success continues to be documented in the medical literature. We review the efficacy and limitations of these contemporary surgical procedures for lymphedema. Methods. A Medline literature review was performed of lymphedema surgery, vascularized lymph node transfer, lymphaticovenous anastomosis, lymphatic liposuction, and lymphaticolymphatic bypass with particular emphasis on developments within the past 10 years. A literature review of technique, indications, and outcomes of the surgical treatments for lymphedema was undertaken.Results. Surgical treatments have evolved to become less invasive and more effective. Conclusions. With proper diagnosis and the appropriate selection of procedure, surgical techniques can be used to treat lymphedema safely and effectively in many patients when combined with integrated lymphedema therapy.Lymphedema is a progressive and debilitating condition associated with dysfunction of the lymphatic system. While a small percentage of cases are congenital, most patients in developed countries present with lymphedema resulting from treatment of malignancy. The true incidence of lymphedema is difficult to determine as a result of significant differences in diagnostic criteria. However, lymphedema is reported to occur in up to 49 % of breast, 20 % of gynecologic, 16 % of melanoma, 10 % of genitourinary, and 6 % head and neck cancer patients after lymph node dissection and/or radiotherapy. Even among patients who undergo isolated axillary sentinel lymph node biopsy, up to 7 % have measurable arm differences, and up to 10 % have subjective symptoms of lymphedema.

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Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

Section: Vascularized Lymph Node Transfer (Vlnt)mentioning

confidence: 99%

Review of Current Surgical Treatments for Lymphedema

et al. 2014

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“…75,76 Lin et al and Cheng et al hypothesized that the transferred lymph nodes act as "lymph pumps", ejecting the absorbed lymph fluid from the surrounding interstitial tissue into the venous circulation via the lymphovenous communication. 77,78 Despite the encouraging results in treating lymphedema, the reported clinical studies involve only patients with chronic lymphedema secondary to iatrogenic injury, which does not reflect the exact pathophysiology of lymphedema associated with a DFU. Furthermore, the surgical complexity and potential morbidity at the donor site of vascularized lymph node transfer may complicate its application.…”

Section: Surgical Managementmentioning

confidence: 99%

Diabetic foot ulcers in conjunction with lower limb lymphedema: pathophysiology and treatment procedures

Kanapathy¹,

Portou²,

Tsui³

et al. 2015

CWCMR

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Diabetic foot ulcers (DFUs) are complex, chronic, and progressive wounds, and have a significant impact on morbidity, mortality, and quality of life. A particular aspect of DFU that has not been reviewed extensively thus far is its management in conjunction with peripheral limb edema. Peripheral limb edema is a feature of diabetes that has been identified as a significant risk factor for amputation in patients with DFU. Three major etiological factors in development of lymphedema with concurrent DFU are diabetic microangiopathy, failure of autonomic regulation, and recurrent infection. This review outlines the pathophysiology of lymphedema formation in patients with DFU and highlights the cellular and immune components of impaired wound healing in lymphedematous DFU. We then discuss the principles of management of DFU in conjunction with lymphedema.

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“…The transferred nodes have been shown to be active in a number of studies. One proposed mechanism suggests that the new lymph nodes act as "pumps" which filter the surrounding fluid (52). The best site for lymph node implantation is currently unknown.…”

Section: Physiologic Techniquesmentioning

confidence: 99%

“…The best site for lymph node implantation is currently unknown. In some cases, the nodes have been placed distally whereas in others they were implanted proximally (52). Welldesigned controlled prospective studies are needed to clarify if the suggested functional surgical methods are beneficial in the long-term.…”

Section: Physiologic Techniquesmentioning

confidence: 99%