With the remarkable advancement of microsurgery,surgical treatment for lymphedema has been increasing,and its good results are well established.However,surgical treatment for advanced-stage lymphedema is still a chall...With the remarkable advancement of microsurgery,surgical treatment for lymphedema has been increasing,and its good results are well established.However,surgical treatment for advanced-stage lymphedema is still a challenging task.We reviewed several methods of combining lymphovenous anastomosis(LVA)and vascularized lymph node transfer(VLNT)in breast cancer-related lymphedema(BCRL)patients.Representative VLNT flap options for BCRL patients include the omental flap,superficial circumflex iliac perforator(SCIP)flap,and deep inferior epigastric artery(DIEA)flap combined with inguinal lymph nodes performed simultaneously with breast reconstruction.The surgical outcome,technical details,and donor site morbidities of each surgical option were reviewed.While all three options show significant surgical benefits,each has its clear advantages and disadvantages.The decision on the surgical method may vary according to the needs of each patient and the clinical situation.展开更多
Breast cancer-related lymphedema(BCRL)is a debilitating disorder affecting an estimated 1 in 5 women and men treated for breast cancer.Fortunately,super microsurgical techniques have advanced in recent years and now p...Breast cancer-related lymphedema(BCRL)is a debilitating disorder affecting an estimated 1 in 5 women and men treated for breast cancer.Fortunately,super microsurgical techniques have advanced in recent years and now provide better options for the treatment of lymphedema,allowing timely surgical intervention that can delay or even prevent lymphatic degeneration.Lymphovenous anastomosis(LVA),a physiologic procedure that restores lymphatic drainage by connecting functioning lymphatic vessels with nearby veins,has been shown to be both minimally invasive and highly effective.The authors describe innovative approaches to LVA that will help optimize outcomes for patients with BCRL.展开更多
Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients...Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients.Methods:An observational,prospective,longitudinal study was designed.20 consecutive patients were treated for lymphedema by means of LVA between 2015 and 2018.All were affected by secondary lymphedema(ISGⅡ-Ⅲ)following lymphadenectomy,radiation or both.All patients received preoperative rehabilitation as well as radiotherapy after oncological surgery.Limb volume was measured before surgery and at one year later.LVA was performed under general anesthesia with ICG guidance.ICG was also used to evaluate postoperative outcomes.Lympho-SPECT-CT was performed in all subjects at their first consultation and at one year after every surgical intervention.Description of findings included an absence of lymph nodes,new lymph node activity in anatomical areas and new lymphatic activity in extra-anatomical areas.Results:Limb volume decreased in 19 patients after LVA.Six patients showed preoperative linear ICG patterns,combined with areas presenting with another type of pattern.After LVA,the linear pattern was observed in 11 patients.SPECT-CT/lymphoscintigraphy before surgery showed a total absence of lymph nodes,except in two cases,in whom small nodes in anatomical locations were described.After LVA,we observed new landmarks in 16 patients corresponding to lymphatic circulation that was not present in preoperative studies.In six cases,newlymphatic activity compatible with lymph nodes was detectable after LVA.The Spearman correlation coefficient was negative when circumferences and lympho-SPECT-CT were tested(P=0.02).Conclusion:Results showed a postoperative decrease in volume that correlated inversely with lympho-SPECT/CT findings.Lympho-SPECT/CT provided additional information related to accurate identification and the anatomical location of lymphatic structures that were not observed before reconstructive surgery.It can be a complementary test to conventional lymphoscintigraphy.展开更多
文摘With the remarkable advancement of microsurgery,surgical treatment for lymphedema has been increasing,and its good results are well established.However,surgical treatment for advanced-stage lymphedema is still a challenging task.We reviewed several methods of combining lymphovenous anastomosis(LVA)and vascularized lymph node transfer(VLNT)in breast cancer-related lymphedema(BCRL)patients.Representative VLNT flap options for BCRL patients include the omental flap,superficial circumflex iliac perforator(SCIP)flap,and deep inferior epigastric artery(DIEA)flap combined with inguinal lymph nodes performed simultaneously with breast reconstruction.The surgical outcome,technical details,and donor site morbidities of each surgical option were reviewed.While all three options show significant surgical benefits,each has its clear advantages and disadvantages.The decision on the surgical method may vary according to the needs of each patient and the clinical situation.
文摘Breast cancer-related lymphedema(BCRL)is a debilitating disorder affecting an estimated 1 in 5 women and men treated for breast cancer.Fortunately,super microsurgical techniques have advanced in recent years and now provide better options for the treatment of lymphedema,allowing timely surgical intervention that can delay or even prevent lymphatic degeneration.Lymphovenous anastomosis(LVA),a physiologic procedure that restores lymphatic drainage by connecting functioning lymphatic vessels with nearby veins,has been shown to be both minimally invasive and highly effective.The authors describe innovative approaches to LVA that will help optimize outcomes for patients with BCRL.
文摘Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients.Methods:An observational,prospective,longitudinal study was designed.20 consecutive patients were treated for lymphedema by means of LVA between 2015 and 2018.All were affected by secondary lymphedema(ISGⅡ-Ⅲ)following lymphadenectomy,radiation or both.All patients received preoperative rehabilitation as well as radiotherapy after oncological surgery.Limb volume was measured before surgery and at one year later.LVA was performed under general anesthesia with ICG guidance.ICG was also used to evaluate postoperative outcomes.Lympho-SPECT-CT was performed in all subjects at their first consultation and at one year after every surgical intervention.Description of findings included an absence of lymph nodes,new lymph node activity in anatomical areas and new lymphatic activity in extra-anatomical areas.Results:Limb volume decreased in 19 patients after LVA.Six patients showed preoperative linear ICG patterns,combined with areas presenting with another type of pattern.After LVA,the linear pattern was observed in 11 patients.SPECT-CT/lymphoscintigraphy before surgery showed a total absence of lymph nodes,except in two cases,in whom small nodes in anatomical locations were described.After LVA,we observed new landmarks in 16 patients corresponding to lymphatic circulation that was not present in preoperative studies.In six cases,newlymphatic activity compatible with lymph nodes was detectable after LVA.The Spearman correlation coefficient was negative when circumferences and lympho-SPECT-CT were tested(P=0.02).Conclusion:Results showed a postoperative decrease in volume that correlated inversely with lympho-SPECT/CT findings.Lympho-SPECT/CT provided additional information related to accurate identification and the anatomical location of lymphatic structures that were not observed before reconstructive surgery.It can be a complementary test to conventional lymphoscintigraphy.
