Treatment Of Upper Extremity Lymphedema Research Articles

Vascularized lymph node transfer with efferent lymphatico-lymphatic anastomosis for treatment of upper extremity lymphedema

Vascularized lymph node transfers (VLNT) are useful options for the surgical treatment of lymphedema. Conventional VLNT does not include the reconstruction of physiological lymphatic outflow, which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis. We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator (SCIP) flap, including VLNT with efferent lymphatico-lymphatic anastomosis. A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap, which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area. The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique. Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap. Postoperatively, lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up. Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.

P252 Comparison of the Effectiveness of Complex Decongestive Therapy Components in the Treatment of Upper Extremity Lymphedema Associated with Breast Cancer

P252 Comparison of the Effectiveness of Complex Decongestive Therapy Components in the Treatment of Upper Extremity Lymphedema Associated with Breast Cancer

Prevention, Diagnosis, and Management of Upper Extremity Lymphedema Complications: Altmetric Analysis of Online Media.

Background:Traditional citation-based metrics do not capture the dissemination of upper extremity lymphedema (UEL) research that occurs online and in mainstream media. There is limited literature reporting the most impactful UEL articles based on citation rate and/or online mentions. We sought to use the Altmetric Attention Score (AAS) to determine the most impactful UEL articles in online media and to report trends in the diagnosis, treatment, and prevention of complications.Methods:The Altmetric database was queried to identify all published articles regarding the management, diagnosis, and prevention of complications seen in the setting of UEL. Extracted data points included article topic and type, journal, and number of online mentions on several platforms.Results:Our index search yielded 638 studies published between 2000 and 2021. Fifty articles with the highest AAS scores were included for analysis. The median AAS was 27.5, but the top four articles had AAS scores that were substantially higher (AAS ≥ 334) than all other studies. Of the top 50 articles, 68% (34/50) were original research. Of those, 23.5% (8/34) were randomized control trials. The most common article topic was the treatment of UEL (36%; 18/50) followed by diagnostic methods of UEL (30%; 15/50). There were a total of 1156 Twitter mentions (median:14) for the top 50 articles. Of all media platforms, news mentions correlated most strongly with AAS (R2 = 0.99, P < 0.001).Conclusions:Our findings suggest that alternative metrics measure distinct components of article impact and add an important dimension to understanding the overall impact of published research on UEL.

Treatment of upper extremity lymphedema with minimally invasive supermicrosurgery technique

A 51-year-old female patient was admitted to our clinic with numbness and anesthesia in the left upper extremity. There was widespread peripheral edema above and below the left elbow. Symptoms of the patient were associated with axillary lymphatic nodular dissection during previous the mastectomy operation. The patient was successfully treated using the supermicrosurgery technique via lymphaticovenular anastomosis.

Vascularized gastroepiploic lymph node transfer significantly improves breast cancer‐related lymphedema

Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple methods have been described and each has significant disadvantages. We performed VLNT in patients with upper extremity lymphedema resulting from breast cancer surgery. We used lymph nodes of the greater curvature of the stomach (VLNTg). We describe outcomes of the patients suffering from postmastectomy lymphedema who received VLNTg for treatment of lymphedema. Harvest from the periphery of the left gastroepiploic vessel was conducted. We retrospectively reviewed data of 24 female patients suffering from lymphedema following breast cancer treatment who underwent lymph node transplantation from 2012 to 2017. Axillary lymphadenectomy had been performed in all cases. In 18 patients, upper limb lymphedema was present for at least 1 year (mean = 5.6 years; range, 1-15 years). In 6 patients, it was present for only a few months (mean = 5 months; range, 3-8 months). The greater curvature of the stomach nodes (VLNTg) is an excellent option for the treatment of upper extremity lymphedema because there is no risk of complications and the scar is easily concealed. Improvement from lymphedema can be expected in a majority of patients.

Cognition and Rehabilitative Treatment of Upper Extremity Lymphedema after Radical Mastectomy

Cognition and Rehabilitative Treatment of Upper Extremity Lymphedema after Radical Mastectomy

Clinical and Psychosocial Outcomes of Vascularized Lymph Node Transfer for the Treatment of Upper Extremity Lymphedema After Breast Cancer Therapy.

BACKGROUND: Secondary lymphedema following breast cancer therapy remains a major problem. Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema that has shown promising results, but limited studies in the United States have investigated outcomes for single-stage VLNT to the axilla. The goal of this prospective, ongoing study was to investigate the clinical, psychosocial, and functional outcomes of patients who underwent VLNT for the treatment of upper extremity lymphedema after breast cancer therapy. VLNT to the axilla were performed on patients with upper extremity lymphedema after breast cancer therapy. Patients were evaluated preoperatively and postoperatively at 1-, 3-, 6-, 9-, and 12-month intervals by circumferential measurements, pain/heaviness scales, and the LYMQOL questionnaire. Fifty patients met the study criteria. Preliminary results showed a decrease in arm volumes by 34.57% at 1month, 52.03% at 3months, 42.34% at 6months, 65.23% at 9months, and 58.68% at 12months. Pain and heaviness consistently decreased over time to 0.38 and 1.67 respectively at 12months. Overall quality of life scores steadily improved from 5.72 preoperatively to 7.79 at 12months. There was a significant decrease in the number of infections of the affected arm postoperatively and a decreased need for physiotherapy. Complications occurred in 17 patients and consisted mainly of minor wound complications. VLNT continues to demonstrate its value as a safe and effective treatment option for lymphedema after breast cancer therapy. Significant reductions in volume are accompanied by a decrease in symptoms and improvement in quality of life.

Vascularized Supraclavicular Lymph Node Transfer for Lower Extremity Lymphedema Treatment

Sir:FigureMicrosurgical methods for lymphedema treatment such as vascularized lymph node transfer are gaining popularity. Most reports of vascularized lymph node transfer have been for the treatment of upper extremity lymphedema, for which superficial groin lymph nodes are typically transferred.1–4 For lymphedema involving the lower extremities, the potential donor sites for lymph nodes are limited. The axillary and submental regions have served as donor sites for vascularized lymph nodes to treat lower extremity lymphedema, but both have major disadvantages.5 Harvesting lymph nodes from the axillary region may cause lymphedema of the upper extremity, and harvest from the submental region results in a visible donor-site scar and the potential for injury to the marginal mandibular nerve. In a search for a better source of vascularized lymph nodes for transfer to treat lower limb lymphedema, we have used the free supraclavicular flap with its deep cervical lymph nodes (Fig. 1). The advantages include no risk of secondary lymphedema or nerve damage at the donor site; in addition, the donor site scar is well hidden. To our knowledge, this is the first report of using the supraclavicular flap as a vascularized lymph node transfer for treatment of lymphedema.Fig. 1: Illustration showing the design of the supraclavicular free flap.The flap is designed as an ellipse in a horizontal orientation just above the clavicle, with the posterior border of the sternocleidomastoid muscle as the midpoint. First, the inferior skin incision is made, and the dissection proceeds lateral to medial until the transverse cervical artery and transverse cervical vein are identified. A handheld Doppler device can be used to identify a perforator; its location can be marked on the skin to facilitate postoperative monitoring. It is not always necessary to visually identify the perforator to the overlying skin; the vessel is small and can be injured if excessive dissection occurs. The larger lymph nodes are often visible and also palpable. Indocyanine green fluorescent dye can be used to confirm the vascularity of the lymph nodes. The recipient site is prepared at the dorsal crease of the ankle, where the anterior tibial artery and veins are dissected out. The flap is transferred to the recipient site, the microvascular anastomoses are performed, and the flap is inset. The donor site is closed primarily. The postoperative course includes gentle wrapping with a compression bandage and elevation. The dangling protocol starts on postoperative day 5, and the patient increases ambulation progressively with full weight-bearing as tolerated (Fig. 2).Fig. 2: (Left) Preoperative view. (Right) Three-month postoperative view. There has been a 23 percent reduction in volume differential, and the leg is significantly softer and lighter. Note the supraclavicular free flap at the ankle.We have used vascularized supraclavicular lymph node transfer for treatment of advanced lymphedema affecting the leg. The donor-site scar is well hidden, and there is no risk of secondary lymphedema or nerve damage at the donor site. Our preliminary results have been very encouraging. Ghazi A. Althubaiti, M.D. Melissa A. Crosby, M.D. David W. Chang, M.D. Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas DISCLOSURE The authors have no financial interests or commercial associations to declare in relation to the content of this article.

Use of Compression Pumps for Treatment of Upper Extremity Lymphedema Following Treatment for Breast Cancer: A Systematic Review

Purpose: The purpose of this systematic review of the literature was to address 2 questions for women with breast cancer related lymphedema: do compression pumps decrease lymphedema when compared with other treatments? What are the recommended treatment parameters for use of compression pumps? Methods: Five databases were searched and 3 tables were developed to organize key variables. The tables were used by 3 researchers to critically appraise each article. Results: Twenty-six abstracts addressed the use of compression pumps for treatment of lymphedema after breast cancer. Only 8 studies met our criteria. Of the 3 randomized controlled trials, only one did not have major methodological flaws. The study did not support the use of an intermittent compression pump for treatment of lymphedema. Discussion and Conclusion: At this time there is no evidence to suggest that the use of an intermittent compression pump in the treatment of upper extremity lymphedema is better than education about arm care and hygiene, nor is there evidence to support the use of one type of pump or treatment regimen over the other. Additional well-designed studies are needed to determine the efficacy of compression pumps, both intermittent and sequential, in the treatment of lymphedema after surgery and/or radiation therapy for breast cancer.

Radical Reduction of Upper Extremity Lymphedema With Preservation of Perforators

Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia. At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy.