Immediate lymphatic reconstruction(ILR)has become increasingly utilized for the prevention of breast cancerrelated lymphedema(BCRL).A growing body of evidence has demonstrated the long-term efficacy of ILR in reducing...Immediate lymphatic reconstruction(ILR)has become increasingly utilized for the prevention of breast cancerrelated lymphedema(BCRL).A growing body of evidence has demonstrated the long-term efficacy of ILR in reducing the rate of BCRL.While certain risk factors for BCRL are well-recognized,such as axillary lymph node dissection,regional lymph node radiation,and elevated body mass index,other potential risk factors such as age and taxane-based chemotherapeutics remain under discussion.Our experience with ILR has highlighted an additional potential risk factor for BCRL.Lymphatic anatomy,specifically compensatory lymphatic channels that bypass the axilla,may play a largely underrecognized role in determining which patients will develop BCRL after ILR.Foundational anatomic knowledge has primarily been based on cadaveric studies that predate the twentieth century.Modern approaches to lymphatic anatomical mapping using indocyanine green lymphography have helped to elucidate baseline lymphatic anatomy and compensatory channels,and certain variations within these channels may act as anatomic risk factors.Therefore,the purpose of this review was to highlight ways in which variations in lymphatic anatomy can inform the application and improve the accessibility of this procedure.As ILR continues to advance and evolve,anatomical mapping of the lymphatic system is valuable to both the patient and lymphatic microsurgeon and is a critical area of future study.展开更多
Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been establ...Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.展开更多
基金partially supported by the National Heart,Lung,and Blood Institute of the National Institutes of Health(https://www.nhlbi.nih.gov/)under Award Number R01HL157991sponsored by the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium,Inc.
文摘Immediate lymphatic reconstruction(ILR)has become increasingly utilized for the prevention of breast cancerrelated lymphedema(BCRL).A growing body of evidence has demonstrated the long-term efficacy of ILR in reducing the rate of BCRL.While certain risk factors for BCRL are well-recognized,such as axillary lymph node dissection,regional lymph node radiation,and elevated body mass index,other potential risk factors such as age and taxane-based chemotherapeutics remain under discussion.Our experience with ILR has highlighted an additional potential risk factor for BCRL.Lymphatic anatomy,specifically compensatory lymphatic channels that bypass the axilla,may play a largely underrecognized role in determining which patients will develop BCRL after ILR.Foundational anatomic knowledge has primarily been based on cadaveric studies that predate the twentieth century.Modern approaches to lymphatic anatomical mapping using indocyanine green lymphography have helped to elucidate baseline lymphatic anatomy and compensatory channels,and certain variations within these channels may act as anatomic risk factors.Therefore,the purpose of this review was to highlight ways in which variations in lymphatic anatomy can inform the application and improve the accessibility of this procedure.As ILR continues to advance and evolve,anatomical mapping of the lymphatic system is valuable to both the patient and lymphatic microsurgeon and is a critical area of future study.
基金partially supported by the National Heart,Lung,and Blood Institute of the National Institutes of Health(https://www.nhlbi.nih.gov/)under Award Number R01HL157991sponsored by the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium,Inc.
文摘Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.
