BACKGROUND Secondary lymphedema after surgical interventions is a progressive,chronic disease that is still not completely curable.Over the past years,a multitude of surgical therapy options have been described.AIM To...BACKGROUND Secondary lymphedema after surgical interventions is a progressive,chronic disease that is still not completely curable.Over the past years,a multitude of surgical therapy options have been described.AIM To summarize the single-center complications in lymph vessel(LVTx)and free vascularized lymph node transfer(VLNT).METHODS In total,the patient collective consisted of 87 patients who were undergoing treatment for secondary leg lymphedema during the study period from March 2010 to April 2020.The data collection was performed preoperatively during consultations,as well as three weeks,six months and twelve months after surgical treatment.In the event of complications,more detailed follow-up checks were carried out.In total n=18 robot-assisted omental lymph node transplantations,n=33 supraclavicular lymph node transplantations and n=36 Lymph vessel transplantations were analyzed.An exemplary drawing is shown in Figure 1.A graphical representation of patient selection is shown in Figure 2.Robotic harvest was performed with the Da Vinci Xi Robot Systems(Intuitive Surgical,CA,United States).RESULTS In total,11 male and 76 female patients were operated on.The mean age of the patients at study entry was:omental VLNT:57.45±8.02 years;supraclavicular VLNT:49.76±4.16 years and LVTx:49.75±4.95 years.The average observation time postoperative was:omental VLNT:18±3.48 mo;supraclavicular VLNT:14.15±4.9 and LVTx:14.84±4.46 mo.In our omental VLNT,three patients showed a slight abdominal sensation of tension within the first 12 postoperative days.No other donor side morbidities occurred.No intraoperative conversion to open technique was needed.Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention.In our LVTx collective,12 cases of donor side morbidity were registered.In one case,surgical intervention was necessary.CONCLUSION Concerning donor side morbidity,robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.展开更多
Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic reson...Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.展开更多
MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive...MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive overview of vascularized omental tissue transfer(VOLT)for lymphedema treatment,a subject of considerable clinical importance.I believe it is appropriate to particularly commend the authors for their detailed analysis of techniques and various surgical options.The discussion on the immunological properties of the omentum and its value as a donor site for lymph nodes was notably insightful.Significant points from this review include the efficacy of VOLT in reducing the volume of limbs with lymphedema and related symptoms,and the insight into the use of robotic surgery,which opens new perspectives on harvesting techniques.I would like to congratulate the authors for their meticulous research because a better level of evidence is needed in the field of lymphedema surgery.This article not only enriches our understanding of lymphedema and its treatment options but also offers a valuable guide for physicians dealing with this debilitating complication.At our center,we perform vascularized omental lymph node transfer for the treatment of limb lymphedema,mainly after gynecological cancer[2,3].展开更多
Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future rese...Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future research.Methods:A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021.Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included.Results:Sixty-six studies met the study criteria.Most studies reported improved limb circumference/volume,reduction or discontinuation of conservative therapy,infection rate reduction,improved PROs,or postoperative imaging findings reflecting functional lymph nodes.There were significantly lower infection rates(P<0.05)and a trend towards improved PROs in patients who received intra-abdominal flaps,but overall few studies reported these outcomes.There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites,or between intra-abdominal vs.extra-abdominal VLNT donor sites,although these outcomes are not uniformly reported.Conclusion:This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites.Though recent investigations address many understudied VLNT donor sites,larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes,which can offer more concrete evidence to guide surgical practice.展开更多
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
Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to har...Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes.This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific,disease-specific and surgery-specific factors in considering recipient sites from the proximal,middle,and distal lower extremity.The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented.An omental flap to the middle lower extremity(mid-thigh,popliteal fossa,or medial calf)is then recommended due to the abundance of lymphatic tissue,proximity to pooled lymph fluid,and avoidance of added bulk or poor cosmesis of the distal lower extremity.However,additional clinical outcomes studies are needed and represent an area of further investigation.展开更多
Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema ...Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.展开更多
Lymphedema continues to be a very challenging clinical problem.While compression and physical therapy remain the foundation of treatment,recent advances in microsurgery and super-microsurgery have allowed for the deve...Lymphedema continues to be a very challenging clinical problem.While compression and physical therapy remain the foundation of treatment,recent advances in microsurgery and super-microsurgery have allowed for the development of promising surgical options.One of these options is vascularized lymph node transfer(VLNT),which has gained significant popularity over recent years.However,there is no consensus on the ideal donor lymph node basin for VLNT.In addition,the most commonly reported donor sites,including the groin,supraclavicular,submental,and lateral thoracic nodes,carry the risk of iatrogenic lymphedema and/or visible scarring.In order to avoid these risks,the use of intra-abdominal donor sites for VLNT has been pursued.This article reviews the reported techniques and outcomes for each of the intra-abdominal donor sites for VLNT.展开更多
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive ...The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.展开更多
Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compres...Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compression.It requires absolute,life-long compliance with treatment by the patient and,in some cases,it is ineffective.In recent years,surgery has emerged as a possible alternative or even,complementary therapy for BCRL.The most commonly reported techniques are reconstructive or debulking procedures.Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process,when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space.In more advanced stages,where fibrotic and hypertrophic adipose tissues are dominant,debulking techniques such as liposuction can be recommended.A standard of care for the treatment of BCRL has not been established.Currently,different techniques can be combined to optimize clinical outcomes,and the surgical approach must be individualized for each patient,based on sound clinical and imaging assessment.BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.展开更多
Patients with breast cancer-related lymphedema(BCRL)commonly present with both debilitating upper extremity symptoms and the need for breast reconstruction.By combining autologous flaps with physiologic lymphatic surg...Patients with breast cancer-related lymphedema(BCRL)commonly present with both debilitating upper extremity symptoms and the need for breast reconstruction.By combining autologous flaps with physiologic lymphatic surgery,postmastectomy patients with BCRL can obtain aesthetic breast reconstruction and lymphedema management in a single operation.Lymph node transfer to an area of lymphatic obstruction creates a healthy lymphatic bridge and restores physiologic flow.Early success and improved understanding of vascularized lymph node transfer(VLNT)physiology have led to the rapid development of numerous flap options and modalities.Several studies have shown the efficacy of combining autologous breast reconstruction with VLNT.Chimeric flaps using inguinal nodes,lateral thoracic nodes,or omentum aim to construct an aesthetic breast and improve lymphatic function.In this article,we will detail the surgical options that accomplish autologous breast reconstruction and restore the lymphatic network in a single operation.展开更多
Surgical treatment for lymphedema has undergone tremendous advancements over the years,with the earliest techniques focusing on ablative procedures such as liposuction and direct excision.With modern advancements in t...Surgical treatment for lymphedema has undergone tremendous advancements over the years,with the earliest techniques focusing on ablative procedures such as liposuction and direct excision.With modern advancements in technology,equipment,imaging,and microscope optics,physiologic procedures have emerged as the standard of care for lymphedema at high-volume institutions and centers of excellence.The lymphovenous bypass and the vascularized lymph node transfer operations have both proven to be effective means for treatment and improving the quality of life of patients suffering from lymphedema.However,with the established foundation of knowledge and experience,innovative approaches to optimize outcomes in patients undergoing supermicrosurgical treatment are constantly evolving.The present review presents a historical review of the lymphovenous bypass and vascularized lymph node transfer procedures and introduces some novel expansions of both techniques in the field of lymphedema surgery.展开更多
文摘BACKGROUND Secondary lymphedema after surgical interventions is a progressive,chronic disease that is still not completely curable.Over the past years,a multitude of surgical therapy options have been described.AIM To summarize the single-center complications in lymph vessel(LVTx)and free vascularized lymph node transfer(VLNT).METHODS In total,the patient collective consisted of 87 patients who were undergoing treatment for secondary leg lymphedema during the study period from March 2010 to April 2020.The data collection was performed preoperatively during consultations,as well as three weeks,six months and twelve months after surgical treatment.In the event of complications,more detailed follow-up checks were carried out.In total n=18 robot-assisted omental lymph node transplantations,n=33 supraclavicular lymph node transplantations and n=36 Lymph vessel transplantations were analyzed.An exemplary drawing is shown in Figure 1.A graphical representation of patient selection is shown in Figure 2.Robotic harvest was performed with the Da Vinci Xi Robot Systems(Intuitive Surgical,CA,United States).RESULTS In total,11 male and 76 female patients were operated on.The mean age of the patients at study entry was:omental VLNT:57.45±8.02 years;supraclavicular VLNT:49.76±4.16 years and LVTx:49.75±4.95 years.The average observation time postoperative was:omental VLNT:18±3.48 mo;supraclavicular VLNT:14.15±4.9 and LVTx:14.84±4.46 mo.In our omental VLNT,three patients showed a slight abdominal sensation of tension within the first 12 postoperative days.No other donor side morbidities occurred.No intraoperative conversion to open technique was needed.Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention.In our LVTx collective,12 cases of donor side morbidity were registered.In one case,surgical intervention was necessary.CONCLUSION Concerning donor side morbidity,robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.
基金supported by the National Natural Science Foundation of China(grant nos.81372080 and 82302822)Shanghai Municipal Key Clinical Specialty(grant no.shslczdzk00901)Shanghai Sailing Program(grant no.21YF1424000).
文摘Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.
文摘MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive overview of vascularized omental tissue transfer(VOLT)for lymphedema treatment,a subject of considerable clinical importance.I believe it is appropriate to particularly commend the authors for their detailed analysis of techniques and various surgical options.The discussion on the immunological properties of the omentum and its value as a donor site for lymph nodes was notably insightful.Significant points from this review include the efficacy of VOLT in reducing the volume of limbs with lymphedema and related symptoms,and the insight into the use of robotic surgery,which opens new perspectives on harvesting techniques.I would like to congratulate the authors for their meticulous research because a better level of evidence is needed in the field of lymphedema surgery.This article not only enriches our understanding of lymphedema and its treatment options but also offers a valuable guide for physicians dealing with this debilitating complication.At our center,we perform vascularized omental lymph node transfer for the treatment of limb lymphedema,mainly after gynecological cancer[2,3].
文摘Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future research.Methods:A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021.Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included.Results:Sixty-six studies met the study criteria.Most studies reported improved limb circumference/volume,reduction or discontinuation of conservative therapy,infection rate reduction,improved PROs,or postoperative imaging findings reflecting functional lymph nodes.There were significantly lower infection rates(P<0.05)and a trend towards improved PROs in patients who received intra-abdominal flaps,but overall few studies reported these outcomes.There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites,or between intra-abdominal vs.extra-abdominal VLNT donor sites,although these outcomes are not uniformly reported.Conclusion:This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites.Though recent investigations address many understudied VLNT donor sites,larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes,which can offer more concrete evidence to guide surgical practice.
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Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes.This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific,disease-specific and surgery-specific factors in considering recipient sites from the proximal,middle,and distal lower extremity.The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented.An omental flap to the middle lower extremity(mid-thigh,popliteal fossa,or medial calf)is then recommended due to the abundance of lymphatic tissue,proximity to pooled lymph fluid,and avoidance of added bulk or poor cosmesis of the distal lower extremity.However,additional clinical outcomes studies are needed and represent an area of further investigation.
文摘Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.
文摘Lymphedema continues to be a very challenging clinical problem.While compression and physical therapy remain the foundation of treatment,recent advances in microsurgery and super-microsurgery have allowed for the development of promising surgical options.One of these options is vascularized lymph node transfer(VLNT),which has gained significant popularity over recent years.However,there is no consensus on the ideal donor lymph node basin for VLNT.In addition,the most commonly reported donor sites,including the groin,supraclavicular,submental,and lateral thoracic nodes,carry the risk of iatrogenic lymphedema and/or visible scarring.In order to avoid these risks,the use of intra-abdominal donor sites for VLNT has been pursued.This article reviews the reported techniques and outcomes for each of the intra-abdominal donor sites for VLNT.
文摘The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.
文摘Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compression.It requires absolute,life-long compliance with treatment by the patient and,in some cases,it is ineffective.In recent years,surgery has emerged as a possible alternative or even,complementary therapy for BCRL.The most commonly reported techniques are reconstructive or debulking procedures.Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process,when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space.In more advanced stages,where fibrotic and hypertrophic adipose tissues are dominant,debulking techniques such as liposuction can be recommended.A standard of care for the treatment of BCRL has not been established.Currently,different techniques can be combined to optimize clinical outcomes,and the surgical approach must be individualized for each patient,based on sound clinical and imaging assessment.BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.
文摘Patients with breast cancer-related lymphedema(BCRL)commonly present with both debilitating upper extremity symptoms and the need for breast reconstruction.By combining autologous flaps with physiologic lymphatic surgery,postmastectomy patients with BCRL can obtain aesthetic breast reconstruction and lymphedema management in a single operation.Lymph node transfer to an area of lymphatic obstruction creates a healthy lymphatic bridge and restores physiologic flow.Early success and improved understanding of vascularized lymph node transfer(VLNT)physiology have led to the rapid development of numerous flap options and modalities.Several studies have shown the efficacy of combining autologous breast reconstruction with VLNT.Chimeric flaps using inguinal nodes,lateral thoracic nodes,or omentum aim to construct an aesthetic breast and improve lymphatic function.In this article,we will detail the surgical options that accomplish autologous breast reconstruction and restore the lymphatic network in a single operation.
文摘Surgical treatment for lymphedema has undergone tremendous advancements over the years,with the earliest techniques focusing on ablative procedures such as liposuction and direct excision.With modern advancements in technology,equipment,imaging,and microscope optics,physiologic procedures have emerged as the standard of care for lymphedema at high-volume institutions and centers of excellence.The lymphovenous bypass and the vascularized lymph node transfer operations have both proven to be effective means for treatment and improving the quality of life of patients suffering from lymphedema.However,with the established foundation of knowledge and experience,innovative approaches to optimize outcomes in patients undergoing supermicrosurgical treatment are constantly evolving.The present review presents a historical review of the lymphovenous bypass and vascularized lymph node transfer procedures and introduces some novel expansions of both techniques in the field of lymphedema surgery.
