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
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
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
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
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
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.
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.
