DIAGNOSIS AND RECONSTRUCTIVE MICROSURGERY IN CASE OF THE LYMPHATIC SYSTEM LESION OF THE UPPER LIMB AFTER MASTECTOMY

Abstract

Purpose: To improve the results of treatment of secondary lymphatic edema in patients after complex treatment of breast cancer and to introduce a method of fluorescent lymphography to assess the stage of lymphedema. Materials and methods: The analysis of the results of examination and treatment of female patients with secondary lymphatic edema of the upper limbs, which appeared after the complex treatment of breast cancer in 2012-2016 was performed. To estimate the prevalence and stage of lymphatic edema all patients underwent fluorescent lymphography with indocyanine green. Based on fluorescent lymphography for each patient treatment algorithm was individually substantiated. Of 40 patients with secondary lymphatic edema 20 (50%) patients underwent surgical and 20 (50%) conservative treatment. The results were divided into early (up to 6 months) and long-term results (6-12 months). Results: In the early period after treatment (up to 6 months) the results of treatment in the surgical and conservative groups were comparable. Long-term results (6-12 months) were significantly higher in the group of patients after inguinal lymph node transplantation in combination with conservative methods than the isolated use of conservative methods. Conclusion: The method of fluorescent lymphography with indocyanine green is modern and accurate for the diagnosis of lymphatic edema. It allows determining the stage and prevalence of lymphatic edema. It is an indispensable tool for visualization of lymph nodes in the allocation of the inguinal lymphatic flap and postoperative control of the functional activity of the transplanted lymph nodes. The combination of lymph node transplant with conservative therapy gives better results than the isolated use of conservative methods.