Extremity Lymphedema Research Articles

Lymphaticovenular Anastomosis as a Treatment for Neurogenic Bladder in Patients With Lower Extremity Lymphedema After Gynecologic Cancer Treatment.

Neurogenic bladder (NB), a complication of gynecological cancer treatment, entails significant symptoms such as loss of urinary urgency, incontinence, and renal dysfunction. To investigate whether lymphatic fluid stagnation at the pelvis causes NB, we investigated the effectiveness of lymphaticovenular anastomosis (LVA) for NB. In this retrospective study between 2014 and April 2024, LVA was performed on 52 patients complaining of preoperative urinary dysfunction with lower extremity lymphedema following pelvic lymphadenectomy in gynecologic cancer treatment. Pre- and postoperative assessments evaluated NB symptoms and volume reduction of lower extremities. With an average follow-up period of 35.0 months, the volume of the affected limbs was reduced in all patients. Symptoms of urinary function were improved in 44 out of 52 patients, as improved urinary urgency, disappearance of incontinence, and independence from self-catheterization. Among 15 patients who underwent pre- and postoperative questionnaire assessment of NB, the mean score of NB severity decreased significantly from 16.9 ± 7.1 points preoperatively to 4.3 ± 3.6 points postoperatively (p < 0.01). The specific reason for NB following gynecologic cancer treatment remains unclear. Our study results suggest that lymphatic fluid stagnation itself might be a reason for NB and LVA could reduce these symptoms.

Debulking Lymphatic Liposuction: Are the Therapeutic Effects Limited to the Treated Limb?

Lymphedema treatment has traditionally focused on region-specific interventions. However, recent evidence suggests otherwise. This study aims to evaluate whether the benefits of liposuction for lymphedema are confined to the treated limb or extend to other areas of the body. Patients who underwent liposuction for extremity lymphedema between January and June 2023 at Cleveland Clinic were included in the study. Patients with less than 1-year follow-up or incomplete post-operative tracking studies were excluded. Pre- and post-operative evaluations included patient report, 3D volumetric measurements, and indocyanine green lymphography (ICGL). Liposuction was performed under general anesthesia with circumferential removal of pathological bulk. Thirty-eight limbs in 36 patients (33 females, 3 males, mean age 58 years) underwent surgery. All reported marked improvements, with some noting the improvements as "life-changing." Improvements in lymphatic functions were observed in all operative limbs (38) and non-operative contralateral limbs (38), with an average volume reduction of 30.0% and 19.5%, respectively. ICGL further confirmed improved lymphatic drainage in all limbs (76). Liposuction, traditionally considered a region-specific treatment for lymphedema, exerts therapeutic effects beyond the surgical site, suggesting broader systemic benefits.

Radiographic Enhancement of Lymph Nodes 9 Months after Omental Lymph Node Transfer

Lymphedema is a frequent complication of breast cancer treatment. As the survival rates of breast cancer continue to increase, the number of women with lymphedema will also increase. Surgical treatment of lymphedema has made significant advances during the past 20 years, and our understanding of these procedures continues to evolve. Vascularized lymph node transfer is an increasingly popular option for surgical treatment of lymphedema; however, the mechanism behind symptomatic relief is not fully understood. A proposed theory for improvement in lymphedema symptoms is lymphangiogenesis and spontaneous regeneration of lymphatic vessels, the timing and degree of which are not well defined. We present the case of a 40-year-old woman with a 10-year history of right upper extremity lymphedema secondary to bilateral mastectomy and right axillary lymph node dissection, who subsequently underwent vascularized omental lymph node transfer and lymphovenous bypass with radiographic evidence of spontaneous lymphatic reconnection within 9 months. To our knowledge, this is the earliest reported radiographic evidence of lymphatic regeneration in a human subject to date, adding to the growing body of evidence to support the therapeutic benefits of vascularized lymph node transfers.

MRI features of primary lower extremity lymphedema: a retrospective analysis of 228 patients

BackgroundThe value of MRI presentation of primary lower extremity lymphedema in assessing the severity of lower extremity lymphedema is uncertain. The purpose of this study was to assess the role of MRI presentation in staging primary lower extremity lymphedema. Methods228 patients with clinically diagnosed primary lower limb lymphoedema from January 2018 to December 2019 in our hospital were enrolled retrospectively. Patients were divided into stages I, II, and III based on the 2020 International Society of Lymphology (ISL) clinical staging standards. Two radiologists assessed the following characteristics of the Short Term Inversion Recovery (STIR) sequence: the extent of edema (longitudinally and transversely), the frequency of MRI manifestations, including the presence of dermal thickening, and the morphology of edema (grid, honeycomb, parallel-lines, banded, crescent, and lymphatic lake). The Kappa test was used to assess interobserver agreement. The chi-square test was used to compare the frequency differences of MRI manifestations between different clinical stages. The Spearman test evaluated the correlation between edema extent and clinical stage. ResultsThe extent of edema was positively correlated with clinical stage, both longitudinally and transversely. When comparing stages, the incidence of dermal thickening in stages II and III was significantly higher than in stage I. The incidence of parallel-lines in stage I was significantly higher than that in stages II and III. The grid and banded sign incidence in stages I and II were significantly higher than in stage III. The incidence of honeycomb in stages II and III was significantly higher than in stage I. The incidence of lymphatic lake and crescent in stage III was significantly higher than in stages I and II (P<0.001). ConclusionSTIR can sensitively diagnose lymphedema and assist in clinical staging. MRI manifestations of primary lower extremity lymphedema in different stages have specific MRI features.

Atypical Milroy's disease with predominant unilateral involvement: a case report

Milroy's disease (MD), known as hereditary lymphedema type I, is a rare autosomal dominant primary lymphedema. It accounts for about twenty percent of all primary lymphedema. MD typically presents clinically with bilateral lower extremity lymphedema. Our case report describes a rare case of MD presenting with unilateral upper and lower extremity lymphedema in a patient admitted to our clinic. A 24-year-old woman who had been followed for lymphedema since the age of 8 was diagnosed with MD at our hospital by physical examination, venous Doppler ultrasound, whole-body lymphoscintigraphy, and molecular genetic testing. Partial improvement was observed with complete decongestive therapy, considered the gold standard treatment for lymphedema. Genetic counseling may be beneficial for the patient and family. Although MD is uncommon in the literature, many more studies are needed to identify carrier variants in the community.

Incidence of Lymphedema and Other Complications in Patients Operated on for Gynecological Cancer Including Utilization of Two Lymph Node Dissection Techniques.

Background: To assess the impact of the lymph node dissection (LND) technique on short- and long-term complications. This retrospective review included patients who underwent hysterectomy, oophorectomy, and pelvic ± para-aortic LND for gynecological malignancies (cervical, endometrial, and ovarian) from 2020 to 2022 in our Gynecological Oncology Surgery clinic. Methods and Results: Among 147 patients who underwent pelvic LND for gynecological malignancy, 48 had procedures involving scissors and 99 had procedures involving unipolar cautery. There was no significant difference in the numbers of extracted pelvic and para-aortic lymph nodes between groups. The extents of LND were comparable between the scissors and unipolar cautery groups (p = 0.945). The scissors group exhibited less fluid drainage between days 2 and 5 postoperatively (1300 [600-3100] vs 1800 [600-3400]; p = 0.038). In terms of primary early and late clinical outcomes, there were no significant differences in lymphocele (16.7% vs 15.2%; p = 0.494) and lymphedema (18.8% vs 17.2%; p = 0.491) rates between groups. Conclusions: After retroperitoneal LND for gynecological malignancy, early complications such as lymphocele and late complications such as lower extremity lymphedema did not significantly differ between procedures using cold scissors and procedures using unipolar cautery.

Noncontrast Ultra-High-Frequency Ultrasound for Preoperative Lymphovenous Mapping in Patients Undergoing Lymphaticovenous Anastomosis Surgery for Extremity Lymphedema.

Noncontrast Ultra-High-Frequency Ultrasound for Preoperative Lymphovenous Mapping in Patients Undergoing Lymphaticovenous Anastomosis Surgery for Extremity Lymphedema.

Effects of Short-Term Educational Hospitalization with Multidisciplinary Approach for Lymphedema on Limb Circumference and Quality of Life.

Background: Lymphedema is an intractable disease requiring lifelong treatment. Daily self-care by the patient is essential; however, establishing care is often difficult. Our hospital offers a short-term educational hospitalization program that involves intensive, multidisciplinary intervention to develop self-care. This study aimed to evaluate the effectiveness of this program. Methods and Results: Among the patients diagnosed with primary or secondary lymphedema who underwent educational hospitalization, 31 cases (33 limbs) were included in this study. The upper extremity lymphedema (UEL) index and lower extremity lymphedema (LEL) index were used for objective evaluation, and the Lymphedema Quality of Life Questionnaire was used for subjective evaluation. The therapeutic effects of educational hospitalization were examined before admission, at discharge, and at 6 months postdischarge. The UEL/LEL index significantly decreased for both the upper and lower limbs after educational hospitalization. In addition, the UEL/LEL index change rate from prehospitalization to 6 months postdischarge was compared between the continued and discontinued exercise groups; the former index showed significantly more improvement than the latter. Comparing the quality of life (QOL) assessments pre- and posthospitalization, statistically significant improvements were observed in all categories, including function, appearance, symptoms, and psychological state. Conclusions: Short-term educational hospitalization led to a sustained reduction in the circumference of lymphedema-affected limbs and an improvement in the QOL. The multidisciplinary approach resulted in improved self-efficacy and established daily self-care.

Chylous Reflux in Pediatric Primary Lymphedema of the Lower Limbs and Genitalia: A Retrospective Study of 167 Patients.

Background: Chylous reflux (CR) in primary lymphedema (PL) of the lower extremities is rare and requires particular diagnostic procedures. This study aimed to determine clinical and lymphoscintigraphic traits for efficient screening. Methods and Results: Pediatric patients with PL of lower extremities treated in our institution between January 2020 and December 2023 were reviewed. The medical history, lymphoscintigraphy, non-contrast MR lymphography, and direct lymphangiography were analyzed. Lymphoscintigraphic visual patterns were classified to detect CR. Patients with CR showed significantly higher proportions of childhood symptom onset (65.63% vs. 25.19%, p < 0.01), genital lymphedema (62.50% vs. 19.26%, p < 0.01), and proximal-to-distal swelling (31.25% vs. 8.89%, p < 0.01). Eight patients without skin lesions had milk discharge after acupuncture or skin breakdown. Pattern 4 shows diffused dermal backflow of the leg and an absence of superficial lymphatic drainage, or normal initial cephalad flow with subsequent reflux of tracer into the affected limb. CR showed significantly higher percentages of pattern 4 (87.50% vs. 12.59%, p < 0.01), normal/widened iliac lymphatics (78.13% vs. 11.11%, p < 0.01), and thigh/calf outlining (87.50% vs. 29.63%, p < 0.01). Genital swelling preceding limb swelling and genital radioactivity were more common in the CR group. Conclusions: CR tends to occur in childhood initially, begin centrally and progress distally, and involve genitals prior to lower extremities. Milk discharge after acupuncture or skin breakdown is important for screening CR without chylous vesicles. The patterns with typical "profiling of the leg" and normal or widened iliac lymphatic trunks strongly correlate with CR. Genital lymphedema with increased radioactivity indicates CR.

Is axillary web syndrome a risk factor for breast cancer-related lymphedema of the upper extremity? A systematic review and meta-analysis.

To systematically review the available literature to determine if axillary web syndrome (AWS) is a risk factor for breast cancer-related lymphedema (BCRL) of the upper extremity. The study is Prospero-registered (ID CRD42024508169) and follows PRISMA guidelines. Ovid MEDLINE, PubMED, CINAHL, Embase, clinicaltrials.gov and the WHO International Clinical Trials Registry Platform were searched February 24, 2024. Original studies including a cohort of females > 18 years of age diagnosed with AWS after breast cancer surgery and assessing BCRL outcome were included. Scoping, mapping, systematic or qualitative reviews, dissertations without peer-review and conference abstracts were excluded. Methodological quality was assessed using the Modified Downs and Black Checklist and overall certainty in the body of evidence was assessed using Cochrane's GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation). Nine cohort studies representing 3218 participants were included. The median incidence of AWS and BCRL was 31.79% (IQR 8.90%) and 14.29% (IQR 19.01%), respectively, across all studies. Pooled analysis indicated an odds ratio of 1.19 (95% confidence interval 0.60,2.37), with substantial heterogeneity across studies (Chi2 p < 0.0001, I2 = 82%). Methodological quality of the included studies was poor to fair, and there was very low certainty evidence indicating no difference in AWS for BCRL risk. The strongest study included, found that AWS more than doubles BCRL risk in the upper extremity. The available evidence base cannot definitively determine whether AWS imparts risk of BCRL. AWS should be considered a potential risk factor for BCRL, until definitive conclusions from future research are available.

The Usefulness of Portable Echo in the Preoperative Mapping of Lymphaticovenular Anastomosis.

This study evaluated the effectiveness of a pocket-sized ultrasound device in preoperative planning for lymphaticovenular anastomosis (LVA) to enhance lymphedema treatment outcomes. A retrospective analysis was performed on 24 patients who underwent LVA for secondary upper extremity lymphedema between June 2020 and August 2022. Patients were categorized into two groups: the ultrasound group, which used a pocket-sized device (Vscan Air), for preoperative vein identification, and a control group that did not. Preoperative lymphatic mapping was performed using indocyanine green lymphography, and suitable veins for anastomosis were identified using ultrasound. Upper extremity lymphedema index and incision length were compared. Participants in the ultrasound group had a shorter average incision length (2.85 ± 0.48 cm) than those in the control group (3.23 ± 0.78 cm, p = 0.038), indicating a more targeted and minimally invasive approach. Although volume reduction rates were not significantly different, the pocket ultrasound device facilitated more precise vein selection, enhancing surgical planning. Pocket-sized ultrasound devices provide a cost-effective and practical solution for vein identification during LVA, particularly in resource-limited settings. While high-frequency ultrasound offers superior resolution, portable devices could become standard tools for lymphatic surgery with continued technological advancement.

Limb Salvage and Treatment of Posttraumatic Lymphedema in a Mangled Lower Extremity

Summary: Post traumatic lymphedema (PTL) is a known complication of extremity trauma that is detrimental to limb form and function, healing, and quality of life. In cases of complex lower extremity trauma with vascular and extensive soft tissue injury, the risk of PTL is increased. However, many trauma patients are lost to follow-up, making the risk and potential management of these patients’ lymphedema difficult to characterize. The purpose of this report is to describe the successful surgical management of PTL secondary to significant lower extremity trauma requiring complex limb salvage reconstruction. A 43-year-old woman involved in a motorcycle accident presented with a Gustilo IIIB right tibial fracture and single-vessel leg. She underwent successful limb salvage with serial debridement, bony fixation, creation of an arteriovenous loop with a contralateral saphenous vein graft, and a chimeric latissimus dorsi-serratus anterior muscle flap. At the 5-month follow-up, she presented with significant right lower extremity lymphedema. She underwent lymphovenous bypass surgery guided by preoperative indocyanine green lymphography, which resulted in a 62% improvement in functional outcome measures, eliminated her prior need for compression garments and inability to wear regular shoes, and sustained improvement at two years follow-up. This case illustrates a near circumferential traumatic defect reconstructed with a muscle flap and successful delayed lymphatic reconstruction with lymphovenous bypass in the same patient.

Advances in Microsurgical Treatment Options to Optimize Autologous Free Flap Breast Reconstruction

Introduction: Reconstructive plastic surgeons have made great strides in the field of breast reconstruction to achieve the best results for patients undergoing treatment for breast cancer. As microsurgical techniques have evolved, these patients can benefit from additional treatment modalities to optimize the results of the reconstruction. Free tissue transfer from alternative donor sites for breast reconstruction is routinely performed, which was not possible in the past. Neurotization is now possible to address the numbness and lack of sensation to the reconstructed breast. For those patients who develop lymphedema of the upper extremity as a result of their breast cancer care, supermicrosurgical options are now available to treat and even to prevent the development of lymphedema. This study presents a narrative review regarding the latest microsurgical advancements in autologous free flap breast reconstruction. Methods: A literature review was performed on PubMed with the key words “autologous free flap breast reconstruction”, “deep inferior epigastric perforator flap”, “transverse upper gracilis flap”, “profunda artery perforator flap”, “superior gluteal artery perforator flap”, “inferior gluteal artery perforator flap”, “lumbar artery perforator flap”, “breast neurotization”, “lymphovenous bypass and anastomosis”, and “vascularized lymph node transfer”. Articles that specifically focused on free flap breast reconstruction, breast neurotization, and lymphedema surgery in the setting of breast cancer were evaluated and included in this literature review. Results: The literature search yielded a total of 4948 articles which were screened. After the initial screening, 413 articles were reviewed to assess the relevance and applicability to the current study. Conclusions: Breast reconstruction has evolved tremendously in recent years to provide the most natural and cosmetically pleasing results for those patients undergoing treatment for breast cancer. As technology and surgical techniques have progressed, breast cancer patients now have many more options, particularly if they are interested in autologous reconstruction. These advancements also provide the possibility of restoring sensibility to the reconstructed breast as well as treating the sequela of lymphedema due to their cancer treatment.

Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema

ObjectiveTo evaluate the lymphatic-specific morbidity (specifically, lower extremity lymphedema) associated with laparoscopic management of early-stage endometrial cancer using the sentinel lymph node (SLN) algorithm by type of actual nodal assessment.MethodsAn...

The Quality of Life after Endometrial Cancer Study: Baseline Characteristics and Patient-Reported Outcomes.

Endometrial cancer (EC) patients make up the second largest group of female cancer survivors. Patient-reported outcomes (PROs) including quality of life (QOL) and sexual function and satisfaction (SF and S) are critical facets of survivorship. This prospective, longitudinal study assesses associations between baseline characteristics and PROs after treatment. Herein, we report the baseline clinical characteristics and PROs prior to treatment initiation. Outcomes post-treatment over time will be reported separately. Patients with planned surgery for EC were prospectively enrolled in 2019-2021 and administered the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ-C30), EORTC QLQ EC Module (EN24), Patient-Reported Outcomes Measurement Information System (PROMIS), and the Mayo Clinic lower extremity lymphedema (LEL) questionnaire. This study enrolled 198 patients with a mean (SD) age of 63.6 (9.8) years and body mass index of 35.5 (8.3) kg/m2. No significant differences in the PROs for the QOL were seen when compared to the reference means (SD) except for the lower interest in sexual activity (31.9 (9.8) vs. 47.5 (SE0.70)) and lower fatigue (21.3 (19.8) vs. 31.7 (25.9)). Increased obesity was associated with an increased likelihood of LEL (p < 0.01) and multiple QOL scales, including poorer global health status (p < 0.01) and physical functioning (p < 0.01). Prior to treatment initiation for EC, the patients had a similar QOL compared to that of the general population. The patients with increasing obesity, a known risk factor for EC, had worse overall global health status and physical functioning. A better understanding of these QOL measures is imperative for earlier identification and intervention of patients at risk of chronic impairments from EC treatment.

Long-term outcomes of sentinel lymph node navigation surgery for early-stage cervical cancer

BackgroundSentinel lymph node navigation surgery, which identifies the sentinel lymph node in early cervical cancers and omits systemic pelvic lymphadenectomy in cases where no lymph node metastasis is present, has recently gained attention. However, there are few reports on lymph node recurrence and the long-term outcomes of cervical cancer surgery performed using sentinel lymph node navigation surgery. In this study, we aimed to evaluate the long-term outcomes of sentinel node navigation surgery for early-stage cervical cancer.MethodsOne hundred thirty-eight patients with cervical cancer were enrolled. Sentinel lymph nodes were identified by injecting 99 m Technetium-labeled phytate and indocyanine green into the uterine cervix. Surgery and survival outcomes were also analyzed.ResultsThe median age and body mass index of the patients were 40 years (20–78) and 21.7 kg/m2 (16.5–50.4), respectively. Open surgery, laparoscopic surgery, and robotic surgery were performed in 77 (56%), 53 (38%), and 8 (6%) patients, respectively. The overall and bilateral detection rates of the sentinel lymph node were 100% and 94%, respectively. Only one case (0.7%) exhibited lower extremity lymphedema, and pelvic lymphocele was observed in three cases (2.2%). Four cases (3%) experienced recurrence over a median follow-up of 57.5 months (range, 2–115 months), with five-year recurrence-free and overall survival rates of 97% and 97.3%, respectively.ConclusionsOur results demonstrate that sentinel node navigation surgery may be safe and effective for early-stage cervical cancer.

Optimizing strategies for lymphaticovenular anastomosis in lower secondary extremity lymphedema

BackgroundLymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with secondary extremity lymphedema. The objective of this study was to optimize strategies for lower secondary extremity lymphedema using LVA techniques, with the aim of enhancing patient outcomes. MethodsWe conducted a retrospective analysis of 121 patients who underwent LVA at Taizhou Hospital of Zhejiang Province from January 2020 to December 2023. Preoperative and postoperative assessments included intraoperative observations, functional parameters, and clinical outcomes. The efficacy of LVA was evaluated based on circumferential reduction, quality of life improvements (Lymphoedema Quality of Life Questionnaire), and postoperative complications. ResultsThis study enrolled 121 patients with lower secondary extremity lymphedema, with an average age of 58.19 years. The results revealed significant associations between incision depth, lymphatic vessel size, the number of LVAs performed, and the number of incisions per patient, all of which correlated with postoperative volume reduction. The resulted analysis that identified optimal incision depths of 10 to 15 mm, lymphatic vessel size of 0.4 to 0.6 mm, and a recommended number of 6 to 8 LVAs. After LVA, there was a marked improvement in patient quality of life, with particularly notable enhancements in functionality and appearance. ConclusionsThis study’s findings optimizing the strategy for LVA surgery recommend the depth of incision, the size of lymphatic vessels, and the number of anastomoses to improve the quality of life and limb volume in patients with secondary lymphedema of the lower limbs.

Results from a comparative study to evaluate the treatment effectiveness of a nonpneumatic compression device vs an advanced pneumatic compression device for lower extremity lymphedema swelling (TEAYS study)

ObjectiveAdvanced pneumatic compression devices (APCDs) have been shown to be effective in treatment of lower extremity lymphedema in the home setting. However, adherence to self-care has been poor, and APCDs require patients to remain immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lower extremity lymphedema vs an APCD. MethodsA randomized, crossover head-to-head study was performed at nine sites in 2023. Patients were randomized to either the NPCD or a commercially available APCD. Patients used the randomly assigned initial device for 90 days with a 4-week washout period before a comparable 90-day use of the second device. ResultsA total of 71 patients (108 affected limbs) with lower extremity lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean decrease in limb edema volume (a mean limb volume decrease of 369.9 ± 68.19 mL [P < .05] vs 83.1 ± 67.99 mL [P < .05]). Significant improvement in Quality of Life was achieved for NPCD and but not for APCD treatment (score improvement of 1.01 ± 0.23 [P < .05] for NPCD vs 0.17 ± 0.18 [P > .05] for APCD). Patients reported greater adherence (81% vs 56%; P < .001) and satisfaction with the NPCD (78% vs 22%) compared with APCD. No device-related adverse events were reported. ConclusionsThe novel NPCD is an effective treatment for decreasing limb volume in patients with lower extremity lymphedema. The NPCD was more effective than an APCD and resulted in superior limb volume decrease, greater improved quality of life, adherence, mobility, and patient satisfaction.

Primary LYmphedema Multidisciplinary Approach in Patients Affected by Primary Lower Extremity Lymphedema.

Background: Primary lymphedema is a chronic condition caused by a developmental abnormality of the lymphatic system, leading to its malfunction. Various surgical options, including physiologic and excisional procedures, have been proposed. The aim of this study was to present a comprehensive algorithm for the treatment of primary lower extremity lymphedema: the Primary LYmphedema Multidisciplinary Approach (P-LYMA). Methods: Nineteen patients were treated following the P-LYMA protocol. Patients underwent pre- and postoperative complex decongestive therapy (CDT). A variety of physiologic and excisional procedures were performed, either independently or in combination. The primary outcome was to assess the circumferential reduction rate (CRR). The Lymphedema Quality of Life Score (LeQOLiS), reduction in the number of cellulitis episodes, and complications were recorded. Results: The mean CRR was 73 ± 20% at twelve months postoperatively. The frequency of cellulitis episodes per year decreased from a mean of 1.9 ± 0.8 preoperatively to 0.4 ± 0.6 during follow-up. Two patients experienced minor complications. The mean hospitalization time was 5 days. Patients' quality of life, as measured by the LeQOLiS, significantly improved from 70.4 ± 12 preoperatively to 24 ± 14 at twelve months postoperatively. Conclusions: The P-LYMA algorithm maximizes surgical outcomes and improves the quality of life in patients with primary lymphedema. CDT is essential for optimizing results.

CORRELATION OF INGUINAL LYMPH NODE NUMBER AND VOLUME WITH LOWER EXTREMITY LYMPHEDEMA SEVERITY

There are very limited studies on the relationship of inguinal lymph node number and volume correlated with lower extremity lymphedema severity. In this IRB-approved retrospective study, patients who obtained an MRI for lower extremity lymphedema and who did not have lymph node resection or biopsy were identified. The MRI images were used to determine the number and volume of inguinal lymph nodes for each limb in addition to fat and fluid-based scoring using a validated grading system. Wilcoxon signed-rank tests were used to compare the greater-affected limbs with the lesser-affected limbs. The spearman- rank correlation was performed on a ‘per limb’ basis for MRI-based scoring and clinical parameters with ipsilateral lymph node number and volume and for differences between the limbs. A total of 32 patients were included. The greater-affected limb had higher MRI fluid scores (median (interquartile range) = 3 (3 - 3) vs. 0 (0 - 1), (p &amp;lt; 0.01) relative to the contralateral limb and had a median fat asymmetry score of 2 (1 - 3). On the per-limb analysis, lymph node number and volume inversely correlated with total MRI scores (ρ = -0.47, p &amp;lt; 0.01 for node number and volume). The difference of lymph node number and volume correlated with MRI score difference (node number: ρ = -0.66, p &amp;lt; 0.01; node volume: ρ = - 0.64, p &amp;lt; 0.01) and perometer difference (node number: ρ = -0.58, p &amp;lt; 0.01; node volume: ρ = - 0.59, p &amp;lt; 0.01). Inguinal lymph node number and volume inversely correlate with lower extremity edema presence and severity.