secondary lymphedema
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Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 117
Author(s):  
Eleonora Nacchiero ◽  
Michele Maruccia ◽  
Fabio Robusto ◽  
Rossella Elia ◽  
Alessio Di Cosmo ◽  
...  

Background and Objectives: Current guidelines have limited the performance of complete lymph node dissection (CLND) for patients with clinically detectable lymphatic metastases. Despite the limitations of this surgical procedure, secondary lymphedema (SL) is an unsolved problem that affects approximately 20% of patients undergoing CLND. Preventive lymphatic–venous micro-anastomoses (PMLVA) has already demonstrated its efficacy in the prevention of SL in melanoma patients with a positive sentinel lymph node biopsy (SLNB), but the efficacy of this procedure is not demonstrated in patients with clinically detectable lymphatic metastases. Materials and Methods: This retrospective cohort study, was performed in two observation periods. Until March 2018, CLND was proposed to all subjects with positive-SLNB andPMLVA was performed in a subgroup of patients with risk factors for SL (Group 1). From April 2018, according to the modification of melanoma guidelines, all patients with detectable metastatic lymph nodes underwent PMLVA during CLND (Group 2). The frequency of lymphedema in subjects undergoing PMLVA was compared with the control group. Results: Database evaluation revealed 172 patients with melanoma of the trunk with follow-up information for at least 6 mounts. Twenty-three patients underwent PMLVA during CLND until March 2018, 29 from April 2018, and 120 subjects underwent CLND without any preventive surgery (control Group). The frequency of SL was significantly lower in both Group 1 (4.3% vs. 24.2%, p = 0.03) and Group 2 (3.5%, p = 0.01). Patients undergoing PMLVA showed a similar recurrence-free periods and overall survival when compared to the control group. Conclusions: PMLVA significantly reduces the frequency of SL both in immediate and delayed CLND. This procedure is safe and does not lead to an increase in length of hospitalization.


Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 68
Author(s):  
Gabriela Durán-Aguilar ◽  
Alberto Rossa-Sierra ◽  
Rita Q. Fuentes-Aguilar

Breast cancer is the most common malignant tumor that affects women in the United States, Europe, and Mexico. As an adverse effect when performing treatments for this condition, secondary lymphedema associated with breast cancer occurs in some cases. This complication occurs due to the interruption of lymphatic flow in the upper extremities in conjunction with other factors such as radiation, sedentary lifestyle, removal of lymph nodes, damage to lymphatic vessels, and others. This article reviews breast cancer incidence, mortality, and survival patterns, confirming that, specifically, lymphedema has high health, social, and economic impacts. Research demonstrates that it fundamentally affects women at an early age. In approximately a third of the cases, it becomes a chronic disease. Therefore, physical therapy is essential for a better quality of life in patients who survive this disease. Surgeries and manual and pharmacological treatments are the current procedures done to reduce to reduce the alterations suffered by patients with lymphedema; however, the success of the treatments depends on each patient’s characteristics. To face this problem, the design of a lymphatic vessel has been proposed to assist the mechanical failure of the damaged lymphatic system. In this work, the design methodology used for the blueprint of the lymphatic vessel is presented, as well as the computer analysis of fluid simulation and the selection of the proposed material, resulting in the production of a micrometric design. In the future, it is expected that a surgeon will be able to implant the design of the vessel to restore lymph flow through the lymphatic system, thus helping to combat lymphedema.


Microsurgery ◽  
2021 ◽  
Author(s):  
Johannes Maximilian Wagner ◽  
Mehran Dadras ◽  
Dominic Ufton ◽  
Julika Huber ◽  
Christoph Wallner ◽  
...  

2021 ◽  
Vol 28 (4) ◽  
pp. 367-382
Author(s):  
Andreea GROSU-BULARDA ◽  
◽  
Flavia Francesca LITA ◽  
Adriana SERBAN ◽  
Florin Vlad HODEA ◽  
...  

Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and secondary etiologies. The most common type of secondary lymphedema in western countries is represented by breast cancer related upper limb lymphedema. This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, consequently impacting the quality of patient’s life. An accurate diagnosis is mandatory, using both clinical and imagistic methods with clear definition disease extent as per standardized staging systems, in order to further provide an adequate therapeutic strategy. The main therapeutic goal in patients with lymphedema is represented by limb volume reduction with subsequent symptoms relief, improving quality of life and avoiding complications such as recurrent infections. Through this paper, we aim to present a comprehensive overview of current therapeutic options of breast cancer upper limb related lymphedema. Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease. Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb. Both types of techniques can be combined to ensure the best functional outcome of the patient.


Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6198
Author(s):  
Dimitrios Dionyssiou ◽  
Alexandros Sarafis ◽  
Antonios Tsimponis ◽  
Asterios Kalaitzoglou ◽  
Georgios Arsos ◽  
...  

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.


Author(s):  
Magnus J. Chun ◽  
Fouad Saeg ◽  
Anna Meade ◽  
Taruni Kumar ◽  
Eman A. Toraih ◽  
...  

2021 ◽  
Author(s):  
Shailesh Agarwal ◽  
Catherine Wu

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


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Hector Lafuente ◽  
Ibon Jaunarena ◽  
Eukene Ansuategui ◽  
Arantza Lekuona ◽  
Ander Izeta

Abstract Background Lymphedema, the accumulation of interstitial fluid caused by poor lymphatic drainage, is a progressive and permanent disease with no curative treatment. Several studies have evaluated cell-based therapies in secondary lymphedema, but no meta-analysis has been performed to assess their efficacy. Methods We conducted a systematic review and meta-analysis of all available preclinical and clinical studies, with assessment of their quality and risk of bias. Results A total of 20 articles using diverse cell types were selected for analysis, including six clinical trials and 14 pre-clinical studies in three species. The meta-analysis showed a positive effect of cell-based therapies on relevant disease outcomes (quantification of edema, density of lymphatic capillaries, evaluation of the lymphatic flow, and tissue fibrosis). No significant publication bias was observed. Conclusion Cell-based therapies have the potential to improve secondary lymphedema. The underlying mechanisms remain unclear. Due to relevant heterogeneity between studies, further randomized controlled and blinded studies are required to substantiate the use of these novel therapies in clinical practice.


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