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      Lymph node transplantation for the treatment of lymphedema

      1 , 2 , 3 , 4 , 1

      Journal of Surgical Oncology

      Wiley

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          Most cited references 49

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          A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle.

          Vascularized groin lymph node flaps have been successfully transferred to the wrist to treat postmastecomy upper limb lymphedema. This study investigated the anatomy, mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap transfer for the treatment of lower limb lymphedema. Bilateral regional submental flaps were dissected from three fresh adult cadavers for histological study. A unilateral submental flap was dissected in another six fresh cadavers after latex injection. The VSLN flap was transferred to the ankles of seven lower extremities in six patients with chronic lower extremity lymphedema. The mean patient age was 61 ± 9.4 years. The average duration of lymphedema symptoms was 71 ± 42.2 months. There was a mean of 3.3 ± 1.5 lymph nodes around the submental artery typically at the junction with the facial artery, on the six cadaveric histological sections. Mean of 2.3 ± 0.8 sizable lymph nodes were dissected and supplied by the submental artery in six cadaveric latex-injected submental flaps. All seven VSLN flaps survived. One flap required re-exploration for venous congestion but was successfully salvaged. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumference was 64 ± 11.5% above the knee, 63.7 ± 34.3% below the knee and 67.3 ± 19.2% above the ankle. The transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema. Copyright © 2012 Elsevier Inc. All rights reserved.
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            A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema.

            The authors prospectively evaluated the efficacy of lymphovenous bypass in patients with lymphedema secondary to cancer treatment.
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              Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema.

              Restoring the continuity of lymphatic drainage by lymphaticovenous or lymphaticolymphatic anastomosis was observed in the short term to be patent but eventually occluded because the elevated interstitial pressure will cause obliteration of these tiny, thin-walled, low-pressure lumens. The purpose of this study was to evaluate the outcome of vascularized groin lymph node transfer using the wrist as a recipient site in patients with postmastectomy upper extremity lymphedema. Between January of 1997 and June of 2005, 13 consecutive patients with a mean age of 50.69 +/- 11.25 years underwent vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. A vascularized groin lymph node nourished by the superficial circumflex iliac vessels was harvested and transferred to the dorsal wrist of the lymphedematous limb. The superficial radial artery and the cephalic vein were used as the recipient vessels. Outcome was assessed by upper limb girth, incidence of cellulitis, and lymphoscintigraphy. All flaps survived, and one flap required reexploration, with successful salvage. No donor-site morbidity was encountered. At a mean follow-up of 56.31 +/- 27.12 months, the mean reduction rate (50.55 +/- 19.26 percent) of the lymphedematous limb was statistically significant between the preoperative and postoperative groups (p < 0.01). The incidence of cellulitis was decreased in 11 patients. Postoperative lymphoscintigraphy indicated improved lymph drainage of the affected arm, revealing decreased lymph stasis and rapid lymphatic clearance. A hypothesis was proposed that the vascularized groin lymph node transfer might act as an internal pump and suction pathway for lymphatic clearance of lymphedematous limb. Vascularized groin lymph node transfer using the wrist as a recipient site is a novel and reliable procedure that significantly improves postmastectomy upper extremity lymphedema.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Journal of Surgical Oncology
                J Surg Oncol
                Wiley
                0022-4790
                1096-9098
                October 09 2018
                October 2018
                August 21 2018
                October 2018
                : 118
                : 5
                : 736-742
                Affiliations
                [1 ]Division of Plastic and Reconstructive SurgeryUniversity of Southern California California
                [2 ]Department of Surgery, Plastic and Reconstructive Surgery, ServiceMemorial Sloan‐Kettering Cancer Center New York
                [3 ]Department of Plastic SurgeryUniversity of Washington Medical Center Washington
                [4 ]Department of Plastic and Reconstructive Surgery, Division of Reconstructive MicrosurgeryChang Gung Memorial Hospital Taiwan
                Article
                10.1002/jso.25180
                © 2018

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