Lympedema Therapies

2021 ◽  
Author(s):  
Shailesh Agarwal ◽  
Catherine Wu
Keyword(s):  
Lymph Node ◽  
Drainage Basin ◽  
Parasitic Infection ◽  
Surgical Techniques ◽  
Lymphatic Drainage ◽  
The United States ◽  
Secondary Lymphedema ◽  
Complete Decongestive Therapy ◽  
Infection Treatment ◽  
Lymph Node Transfer

Secondary lymphedema refers to a condition in which the affected extremity develops progressive hypertrophy due to lymphatic fluid retention. Worldwide, secondary lymphedema is most often associated with parasitic infection; within the United States, secondary lymphedema is most often caused by surgical disruption of the lymphatic drainage basins due to cancer surgery and/or radiation. For patients with lymphedema secondary to parasitic infection, treatment of the offending infectious organism (Wuchereria bancroftii) is critical. For patients with surgical disruption of the lymphatic drainage basin(s), patients are first managed non-operatively with compression and manual lymphatic drainage massage. Over the past decade, surgical techniques have been developed and implemented to improve lymphatic drainage for patients with post-surgical secondary lymphedema. These procedures, including lymphovenous bypass or vascularized lymph node transfer, are aimed at reconstituting lymphatic drainage and reducing lymphatic retention to alleviate early lymphedema. An appreciation of the underlying physiology responsible for secondary lymphedema, and diagnosis and management is required to provide timely and appropriate care for these patients. This review contains 2 tables, 4 figures, and 32 references Keywords: lymphedema, lymphedema treatment, secondary lymphedema, complete decongestive therapy, lymphovenous bypass, vascularized lymph node transplantation, debulking surgery, ICG lymphangiography, lymphedema staging

scholarly journals Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6198
Author(s):  
Dimitrios Dionyssiou ◽  
Alexandros Sarafis ◽  
Antonios Tsimponis ◽  
Asterios Kalaitzoglou ◽  
Georgios Arsos ◽  
...  
Keyword(s):  
Lymph Node ◽  
Major Complication ◽  
Vascular Pedicle ◽  
Long Term Outcomes ◽  
Secondary Lymphedema ◽  
Lymph Node Transfer ◽  
The Impact ◽  
Vascularized Lymph Node Transfer

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (<25 cm2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR.

scholarly journals Surgical treatment of lymphedema

2020 ◽  
Vol 63 (4) ◽  
pp. 206-213 ◽  
Author(s):  
Il-Kug Kim ◽  
Hak Chang
Keyword(s):  
Lymph Node ◽  
Surgical Treatment ◽  
Lymphatic Vessels ◽  
Compression Therapy ◽  
Lymphatic Drainage ◽  
Vascular Supply ◽  
Lymphatic Circulation ◽  
Lymph Node Transfer ◽  
Lymphatic Fluid ◽  
Vascularized Lymph Node Transfer

Lymphedema is a debilitating and progressive condition, which results in the accumulation of lymphatic fluid within the interstitial compartments of tissues and hypertrophy of adipose tissue due to the impairment of lymphatic circulation. The mainstay of current lymphedema treatment is nonsurgical management such as complex decongestive therapy and compression therapy. Recently, surgical treatment of lymphedema based on microsurgery has been developed to enable the functional recovery of lymphatic drainage and has complemented nonsurgical treatment. Lymphaticovenular anastomosis and vascularized lymph node transfer are representative physiologic surgeries in the treatment of lymphedema. Lymphaticovenular anastomosis is conducted to drain lymphatic fluid from obstructed lymphatic vessels to the venous circulation through surgically created lymphaticovenous shunts. Vascularized lymph node transfer involves harvesting lymph nodes with their vascular supply and transferring this vascularized tissue to the lymphedema lesion as a free flap. In addition to physiologic surgeries, ablative surgeries such as direct excision and liposuction also can be performed, especially for end-stage cases. Indications for surgical treatment vary across institutions. It is important not to delay physiologic surgery in mild to moderate cases of lymphedema.

Reestablishment of Lymphatic Drainage after Vascularized Lymph Node Transfer in a Rat Model

2018 ◽  
Vol 142 (4) ◽  
pp. 503e-508e ◽  
Author(s):  
Marc Najjar ◽  
Marcos M. Lopez ◽  
Alberto Ballestin ◽  
Naikhoba Munabi ◽  
Alexandra I. Naides ◽  
...  
Keyword(s):  
Lymph Node ◽  
Rat Model ◽  
Lymphatic Drainage ◽  
Lymph Node Transfer ◽  
Vascularized Lymph Node Transfer

Lymphatic Tissue Engineering: A Further Step for Successful Lymphedema Treatment

2021 ◽  
Author(s):  
Andreas Spörlein ◽  
Patrick A. Will ◽  
Katja Kilian ◽  
Emre Gazyakan ◽  
Justin M. Sacks ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Lymph Node ◽  
Lymphatic Vessels ◽  
Lymphatic Tissue ◽  
Oncologic Surgery ◽  
Secondary Lymphedema ◽  
Microsurgical Techniques ◽  
Lymph Node Transfer ◽  
Lymphovenous Anastomosis ◽  
Lymph Node Harvesting

Abstract Background Secondary lymphedema, caused by oncologic surgery, radiation, and chemotherapy, is one of the most relevant, nononcological complications affecting cancer survivors. Severe functional deficits can result in impairing quality of life and a societal burden related to increased treatment costs. Often, conservative treatments are not sufficient to alleviate lymphedema or to prevent stage progression of the disease, as they do not address the underlying etiology that is the disruption of lymphatic pathways. In recent years, lymphatic surgery approaches were revolutionized by advances in microsurgical technique. Currently, lymphedema can effectively be treated by procedures such as lymphovenous anastomosis (LVA) and lymph node transfer (LNT). However, not all patients have suitable lymphatic vessels, and lymph node harvesting is associated with risks. In addition, some data have revealed nonresponders to the microsurgical techniques. Methods A literature review was performed to evaluate the value of lymphatic tissue engineering for plastic surgeons and to give an overview of the achievements, challenges, and goals of the field. Results While certain challenges exist, including cell harvesting, nutrient supply, biocompatibility, and hydrostatic properties, it is possible and desirable to engineer lymph nodes and lymphatic vessels. The path toward clinical translation is considered more complex for LNTs secondary to the complex microarchitecture and pending final mechanistic clarification, while LVA is more straight forward. Conclusion Lymphatic tissue engineering has the potential to be the next step for microsurgical treatment of secondary lymphedema. Current and future researches are necessary to optimize this clinical paradigm shift for improved surgical treatment of lymphedema.

scholarly journals Current knowledge of Chagas-related heart disease among pediatric cardiologists in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sanchi Malhotra ◽  
Imran Masood ◽  
Noberto Giglio ◽  
Jay D. Pruetz ◽  
Pia S. Pannaraj
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Heart Disease ◽  
Chagas Disease ◽  
Latin American ◽  
Current Knowledge ◽  
Parasitic Infection ◽  
The United States ◽  
Cardiac Complications ◽  
The U.S

Abstract Background Chagas disease is a pathogenic parasitic infection with approximately 8 million cases worldwide and greater than 300,000 cases in the United States (U.S.). Chagas disease can lead to chronic cardiomyopathy and cardiac complications, with variable cardiac presentations in pediatrics making it difficult to recognize. The purpose of our study is to better understand current knowledge and experience with Chagas related heart disease among pediatric cardiologists in the U.S. Methods We prospectively disseminated a 19-question survey to pediatric cardiologists via 3 pediatric cardiology listservs. The survey included questions about demographics, Chagas disease presentation and experience. Results Of 139 responses, 119 cardiologists treat pediatric patients in the U.S. and were included. Most providers (87%) had not seen a case of Chagas disease in their practice; however, 72% also had never tested for it. The majority of knowledge-based questions about Chagas disease cardiac presentations were answered incorrectly, and 85% of providers expressed discomfort with recognizing cardiac presentations in children. Most respondents selected that they would not include Chagas disease on their differential diagnosis for presentations such as conduction anomalies, myocarditis and/or apical aneurysms, but would be more likely to include it if found in a Latin American immigrant. Of respondents, 87% agreed that they would be likely to attend a Chagas disease-related lecture. Conclusions Pediatric cardiologists in the U.S. have seen very few cases of Chagas disease, albeit most have not sent testing or included it in their differential diagnosis. Most individuals agreed that education on Chagas disease would be worth-while.

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