scholarly journals Simultaneous Supraclavicular Lymph Node Transfer and Lymphovenous Anastomosis for the Surgical Treatment of End-Stage Lymphedema

2021 ◽  
Author(s):  
Kyung-Chul Moon ◽  
In-Jae Yoon
Keyword(s):  
Lymph Node ◽  
Lower Extremity ◽  
Nonsurgical Management ◽  
Inguinal Area ◽  
History Of ◽  
Lymph Node Transfer ◽  
Lymphovenous Anastomosis ◽  
The Right ◽  
End Stage ◽  
Vascularized Lymph Node Transfer

Abstract BackgroundVarious surgical options are available to treat lymphedema, such as direct excisional debulking surgery, suction-assisted lipectomy debulking, lymphovenous anastomosis (LVA), and vascularized lymph node transplantation (VLNT). However, no studies have addressed simultaneous surgery with both LVA and VLNT for patients with advanced-stage lymphedema. Case Presentation A 72-year-old female with bilateral lower extremity lymphedema refractory to nonsurgical management was admitted to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. The patient underwent simultaneous vascularized lymph node transfer and lymphovenous anastomosis for treatment of end-stage lymphedema. Significant reduction in circumference and volume of lower extremity was achieved following simultaneous vascularized lymph node transfer and lymphonvenous anastomosis Conclusion The authors recommend simultaneous VLNT and LVA surgeries as the first treatment option for patients with end-stage lymphedema.

Surgical Treatment of Advanced Lymphatic Filariasis of Lower Extremity Combining Vascularized Lymph Node Transfer and Excisional Procedures

2019 ◽  
Vol 17 (6) ◽  
pp. 637-646
Author(s):  
Ram M. Chilgar ◽  
Sujit Khade ◽  
Hung-Chi Chen ◽  
Pedro Ciudad ◽  
Matthew Sze-Wei Yeo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Surgical Treatment ◽  
Lower Extremity ◽  
Lymphatic Filariasis ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

scholarly journals Recurrent Advanced Lower Extremity Lymphedema Following Initial Successful Vascularized Lymph Node Transfer: A Clinical and Histopathological Analysis

2017 ◽  
Vol 44 (1) ◽  
pp. 87-89 ◽  
Author(s):  
Pedro Ciudad ◽  
Shivprasad Date ◽  
Oscar J Manrique ◽  
Wei-Ling Chang ◽  
Tsung-Chun Huang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lower Extremity ◽  
Histopathological Analysis ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

scholarly journals Contralateral Vascularized Lymph Node Transfer: An Optimized Mouse Model

2019 ◽  
Vol 04 (02) ◽  
pp. e83-e91
Author(s):  
Giulia Virginia Vottero ◽  
Florent Morfoisse ◽  
Tania Durré ◽  
Silvia Blacher ◽  
Guillaume Becker ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mouse Model ◽  
Donor Site ◽  
Experimental Studies ◽  
Inguinal Region ◽  
Preclinical Model ◽  
Group 4 ◽  
Lymph Node Transfer ◽  
The Right ◽  
Vascularized Lymph Node Transfer

Abstract Background Vascularized lymph node transfer (VLNT) is one of the surgical options in the treatment of lymphedema, but its mechanism of action has not yet been firmly clarified. In the VLNT mouse models described so far, the lymph node flap is performed between two different sites in the same lymphedematous paw. In this study, we describe an optimized VLNT mouse model using the contralateral paw as donor site, thus removing the bias of transferring a lymph node already damaged by irradiation and/or surgery required to induce lymphedema. Methods A lymphedema was induced on the left posterior paw in four experimental groups of mice (n = 8). Two weeks later, group 1 was the sham one, group 2 underwent a VLNT from the right inguinal region to the left, in group 3 a vascular endothelial growth factor (VEGF)-C sponge was placed alone in the left inguinal region, and in group 4 a VEGF-C sponge was associated to the VLNT. The 32 mice were followed during 3 months. Outcomes included paws volume, skin quality, inflammation in the lymphedematous tissue, and lymphatic network density and function. Results Group 4 displayed significantly higher (p < 0.05) lymphedema regression compared with the other three groups. Conclusions This optimized mouse model of VLNT shows to be handy and effective. It could be exploited to perform further experimental studies about the influence of VLNT on lymphedema. Moreover, the local association between VLNT and biological compounds in this model allows it to be a good preclinical model to identify new potential drugs in lymphedema.

scholarly journals Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review

2019 ◽  
Vol 52 (01) ◽  
pp. 081-092 ◽  
Author(s):  
Pedro Ciudad ◽  
M. Diya Sabbagh ◽  
Mouchammed Agko ◽  
Tony C.T. Huang ◽  
Oscar J. Manrique ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Surgical Management ◽  
Fibrous Tissue ◽  
Comprehensive Treatment ◽  
Delayed Presentation ◽  
Lymph Node Transfer ◽  
Lymphovenous Anastomosis ◽  
Protein Rich ◽  
Vascularized Lymph Node Transfer ◽  
Increased Susceptibility

AbstractLymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.

Comparisons in long‐term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Pedro Ciudad ◽  
Oscar J. Manrique ◽  
Samyd S. Bustos ◽  
John J. P. Coca ◽  
Chang‐Cheng Chang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lower Extremity ◽  
Clinical Outcomes ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer
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