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1.
Plast Reconstr Surg ; 145(2): 459-467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
2.
J Surg Oncol ; 121(1): 51-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31612513

RESUMO

BACKGROUND: The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)-lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. MATERIALS AND METHODS: In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. RESULTS: In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2-6) at each patient. Of the ultrasound-detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. CONCLUSION: Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG-lymphangiography.


Assuntos
Anastomose Cirúrgica/métodos , Vasos Linfáticos/diagnóstico por imagem , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Linfocintigrafia , Masculino , Ultrassonografia/métodos
3.
J Surg Oncol ; 121(1): 91-99, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650565

RESUMO

BACKGROUND: Lymphedema surgery was not widely known in Austria before the introduction of lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in 2014. This study shares the experience and process of establishing and institutionalizing lymphedema surgery service in Austria. METHODS: The purpose of introducing reconstructive lymphedema surgery in Austria was to improve lymphedema patients' quality of life and provide them surgical therapy as an adjuvant treatment to complete decongestive therapy. To initialize reconstructive lymphedema surgery in Austria, LVA and VLNT had to be presented and introduced, in the manner of branding and advertizing a new product. Surgeries were performed with quality control by standardized documentation, pre- and postoperatively. RESULTS: Aligned with branding and marketing, presentations were given externally and internally to share knowledge and experience of lymphedema surgery. Lymphedema surgery service was introduced as a new brand in the medical service in Austria. After several communications with the Austrian Health Insurance Fund and with the final application, LVA and VLNT were listed as novel surgical therapies in its 2020 reimbursement catalog. Since 2014, more than 300 lymphedema patients were consulted, and 102 reconstructive lymphedema surgeries were performed. Circumference reduction of extremities after surgery was between 20% and 43%, postoperatively. CONCLUSION: Acceptance of surgery in lymphedema patients varies among continents, hospitals, and surgeons. Evaluation of the requirement of the surgical setup and insurance conditions for lymphedema surgery is essential to establish lymphedema surgery, providing targeted marketing and branding to spread knowledge of the novel technique and grant patients access to therapeutic treatment of their chronic disease.


Assuntos
Cirurgia Geral/organização & administração , Linfedema/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Áustria , Criança , Feminino , Humanos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Centro Cirúrgico Hospitalar , Adulto Jovem
4.
J Surg Oncol ; 121(1): 182-186, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31228351

RESUMO

This is a case report of a 68-year-old male with stage III right lower extremity lymphedema following right inguinal lymph node dissection and adjuvant chemoradiotherapy for Hodgkin's lymphoma. He developed peripheral neuropathy and radiation-induced right femoral artery thrombosis, treated with saphenous vein graft. He underwent three vascularized lymph node transfers (VLNTs) to the upper medial thigh, posterior calf, and ankle with placement of nanofibrillar collagen scaffolds. Three months after surgery, he had volume reduction, less neuropathic pain, and improved ambulation.


Assuntos
Linfedema/complicações , Linfedema/cirurgia , Doenças do Sistema Nervoso Periférico/complicações , Doenças Vasculares Periféricas/complicações , Idoso , Humanos , Linfedema/diagnóstico por imagem , Linfedema/patologia , Masculino , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/patologia , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/patologia
5.
J Surg Oncol ; 121(1): 138-143, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31276208

RESUMO

BACKGROUND: Vascularized lymph node transfer (VLNT) has become one of the effective surgical treatments for extremity lymphedema. This study was to evaluate the re-exploration and total complication rates of VLNT for lower extremity lymphedema between two different flap inset techniques. METHODS: Sixty-nine patients who underwent 74 submental VLNT transfers between 2008 and 2018 were retrospectively studied. Fifty-six flaps were inset using a new delayed primary retention suture (DPRS) technique and other 18 flaps using conventional interrupted sutures as the non-DPRS group. RESULTS: The overall flap success rate was 100%. The DPRS group was released at a mean of 1.7 ± 0.7 times and took a mean of 10.3 ± 3.3 days for wound closure. There were no statistical differences in demographics, mean symptom duration, and mean Cheng's Lymphedema Grading between two groups. Mean frequency of cellulitis of 2.5 ± 1.5 times/year in non-DPRS group was significantly greater than 1.4 ± 1.6 times/year in DPRS group (P = .01). The re-exploration and total complication rates were 5.4% and 7.1% in DPRS group, and 27.8% and 33.3% in non-DPRS group, respectively (P = .02 and .02, respectively). CONCLUSIONS: The DPRS technique is a safe, simple, and reliable method for insetting the submental VLNT, which statistically decreased the re-exploration and total complication rates.


Assuntos
Linfonodos/irrigação sanguínea , Linfonodos/transplante , Linfedema/cirurgia , Retalhos Cirúrgicos/cirurgia , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Extremidades/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
6.
J Surg Oncol ; 121(1): 129-137, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31246288

RESUMO

BACKGROUND: Vascularized submental lymph node (VSLN) transfer is an emerging approach for extremity lymphedema. This study investigated the long-term outcome and venous complications of VSLN for unilateral lower extremity lymphedema. METHODS: Between 2010 and 2018, patients who underwent VSLN for unilateral lower extremity lymphedema were retrospectively evaluated. Patient demographics, operative records, complications, circumferential improvement, and episodes of cellulitis were analyzed. Further comparisons were performed between different types, numbers, and techniques of venous anastomoses. RESULTS: A total of 75 VSLNs in 70 patients survived, giving a 100% success rate. Six flaps (8%) had venous complications (VC group) and 69 flaps (92%) did not (No-VC group). There were no statistical differences in types, numbers, and techniques of anastomoses between two groups (P = .65, 1, and .56, respectively). At a mean follow-up of 32.0 ± 23.0 months, mean circumferential improvement and episodes of cellulitis between two groups did not statistically differ significantly (P = .31 and .09, respectively). CONCLUSIONS: VSLN is an effective treatment for lower extremity lymphedema. The types, numbers of veins, and techniques of venous anastomoses did not statistically affect the venous complication rates. Functional outcomes of the VSLNs were not compromised if venous complications were salvaged promptly.


Assuntos
Linfedema/cirurgia , Linfonodo Sentinela/transplante , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia , Celulite (Flegmão) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Linfonodo Sentinela/irrigação sanguínea , Resultado do Tratamento
7.
J Surg Oncol ; 121(1): 121-128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31209884

RESUMO

Secondary lymphedema is a worldwide affliction that exacts a significant public health burden. This review examines the etiology, presentation, and management of secondary lymphedema. In addition, emerging adjunctive strategies are explored, specifically evidence from animal and pilot human studies regarding implantation of a collagen nanofibrillar scaffold (BioBridge™; Fibralign Corporation, Union City, CA) in promoting lymphangiogenesis, preventing and treating lymphedema, and enhancing outcomes with lymphaticovenous anastomosis and vascularized lymph node transfer.


Assuntos
Colágeno , Linfedema/cirurgia , Tecidos Suporte , Animais , Humanos , Linfonodos/cirurgia , Linfangiogênese , Modelos Animais , Nanofibras , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Engenharia Tecidual
9.
J Surg Oncol ; 121(1): 8-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31309553

RESUMO

The hands-on supermicrosurgery course provided participants a valuable learning experience of in-depth practices of supermicrosurgical skills with experts. Seven live surgeries were successfully demonstrated at 8th World Symposium for Lymphedema Surgery. Variable donor sites for vascularized lymph node transfer were the submental, supraclavicular, groin, and omental; while the recipient sites included the wrist and axilla in upper limb; and popliteal and groin in the lower limb. The therapeutic and preventive lymphovenous anastomosis was also satisfactorily performed.


Assuntos
Linfedema/cirurgia , Microcirurgia/educação , Microcirurgia/métodos , Adulto , Idoso , Feminino , Humanos , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
J Surg Oncol ; 121(1): 175-181, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31165487

RESUMO

BACKGROUND AND OBJECTIVES: Milroy disease is a form of congenital primary lymphedema affecting the lower limbs. When conservative management is ineffective, surgical treatment becomes necessary. The purpose of this study was to investigate the efficacy of vascularized lymph node transfer (VLNT) associated with extensive therapeutic lipectomy in the treatment of these patients. METHODS: In China Medical University Hospital, four patients have been diagnosed with Milroy disease and treated over an 8 year-period time. All patients presented with hereditary bilateral legs swelling since birth. All patients were treated with VLNT from the gastroepiploic region bilaterally associated with extensive therapeutic lipectomy. RESULTS: All procedures have been executed bilaterally and have been successful, without complications. The average follow-up of the patients was 20.2 ± 2.8 months. The limbs treated presented an average circumference reduction of a 4.0 ± 2.1 cm and patients did not experience cellulitis during follow-up. Patients expressed satisfaction with the procedure. CONCLUSIONS: VLNT together with therapeutic lipectomy proved to be a reliable technique in moderate cases of Milroy disease, providing an alternative path for lymph drainage, and reducing the lymph load and the excess of subcutaneous adipose tissues, thus improving patients' quality of life.


Assuntos
Linfonodos/transplante , Linfedema/cirurgia , Adolescente , Feminino , Humanos , Perna (Membro)/cirurgia , Lipectomia/métodos , Linfonodos/irrigação sanguínea , Linfonodos/cirurgia , Masculino
11.
J Surg Oncol ; 121(1): 168-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31168837

RESUMO

BACKGROUND AND OBJECTIVES: In patients with lymphedema, the disruption of the lymphatic network increases skin turgor and fibrosis of subcutaneous tissue, delays wound healing, causing recurrent ulcerations and infections. In these cases, management of ulcers can be challenging. METHODS: Between January 2016 and June 2018, patients presenting with lymphedema were enrolled at our Institution. We selected patients with severe lymphedema and ulcers of lower limbs and we performed a surgical approach, involving free gastroepiploic lymph nodes and omentum flap, harvested through laparoscopy. RESULTS: We enrolled 135 patients presenting for lymphedema. Among them, 10 eligible cases underwent excision of the ulcer and reconstruction with omentum flap. Mean age was 57.8 years and average follow-up 24.1 months. Circumferences and skin tonicity significantly decreased from the preoperative period. Lymphoscintigraphy showed improvement of the lymphatic drainage and restoration of lymphatic network. No episodes of infection were recorded in the postoperative period. CONCLUSIONS: Our combined procedure merges free flap techniques and lymphedema surgery: omentum covers the defect while providing a new source of lymph nodes, improving the lymphatic networks of the affected limb. This technique can highly increase the quality of life of the patient in a single-stage operation with fast recovery and low donor site morbidity.


Assuntos
Retalhos de Tecido Biológico/transplante , Úlcera da Perna/cirurgia , Linfonodos/transplante , Linfedema/cirurgia , Omento/transplante , Idoso , Doença Crônica , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Úlcera da Perna/complicações , Linfonodos/cirurgia , Linfedema/complicações , Masculino , Pessoa de Meia-Idade
12.
J Surg Oncol ; 121(1): 57-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31197837

RESUMO

INTRODUCTION: Patients with pre-existing lymphedema who undergo total knee arthroplasty (TKA) for osteoarthritis (OA) are at high risk for periprosthetic joint infection. This complication usually requires removal of the implant. This study aimed to investigate whether surgical treatment of lymphedema reduces the rate of prosthesis removal in such patients. MATERIALS AND METHODS: We retrospectively reviewed our prospective database of patient information collected between January 2009 and December 2018. A total of 348 cases of lower extremity lymphedema were reviewed, and those who underwent total knee TKA for OA of the knee were included. Patient demographics, clinical data, lymphedema surgical history, and TKA surgical history including any episodes of removal were collected and analyzed. RESULTS: There were nine of 15 lymphedema patients with knee OA who subsequently underwent TKA. The mean patient age was 70.4 ± 7.1 years. A total of 18 TKAs were performed in nine patients. The knee prosthesis removal rate was 66.7% (12/18). The prosthesis removal rate was 40% (2/5) in patients who underwent lymphedema microsurgery vs 76.9% (10/13) for those who did not (P = .03). CONCLUSIONS: Pre-existing lymphedema is associated with a high rate of knee prosthesis removal. Lymphedema microsurgery reduced the removal rate of knee prostheses. We recommend that lymphedema microsurgery be considered for patients who require TKA as a treatment for of the knee.


Assuntos
Artroplastia do Joelho/efeitos adversos , Remoção de Dispositivo , Prótese do Joelho , Linfedema/cirurgia , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Linfedema/fisiopatologia , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Cir. plást. ibero-latinoam ; 45(4): 395-402, oct.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186026

RESUMO

Introducción y objetivo: El colgajo submentoniano ha sido descrito como alternativa para la cobertura de defectos cutáneos en tercio medio e inferior de la cara y como colgajo microquirúrgico para tratamiento del linfedema secundaria de extremidades, al incorporar en su diseño nódulos linfáticos vascularizados. El presente estudio pretende justificar el uso del colgajo submentoniano en sus distintas variantes con la incorporación tradicional de músculo digástrico, perforante de arteria submentoniana, de flujo reverso o microquirúrgico, y con mínima morbilidad del sitio donador. Material y método: Presentamos una serie de 8 pacientes en los que realizamos un colgajo submentoniano para cobertura de defectos en tercio medio e inferior de cara y de linfedema secundario de extremidad superior. Los colgajos tuvieron dimensiones de 40 a 84 cm2 (media de 62 cm2). Los colgajos fueron pediculados con base en la arteria submentoniana en 4 casos (50%), con preservación del músculo digástrico basado en un vaso perforante de la arteria submentoniana en 2 casos, como colgajo submentoniano de flujo reverso en 1 caso, y como colgajo submental linfático vascularizado en 1 caso. Resultados: Recogimos como complicación una necrosis parcial distal de un 20% en un colgajo submentoniano de flujo reverso, que fue tratada con cicatrización dirigida a segunda intención. La zona donadora se trató en todos los casos con cierre primario. Conclusiones: En nuestra opinión, el colgajo submentoniano es una herramienta útil en la reconstrucción de tejidos blandos del tercio medio e inferior de la zona facial, con un grosor, textura y coloración similares, así como una alternativa en el tratamiento del linfedema secundaria de la extremidad superior


Background and objective: The submental flap has been previously described as an alternative for the coverage of cutaneous defects or the middle and lower thirds of the face, as well as a vascularized lymph node flap for the treatment of secondary lymphedema of the extremities. Our goal is to justify its clinical application, and the use of the variants of the components of the flap and design, either with the inclusion of the digastric muscle, submental perforator, reverse flow or microvascular flap, with minimal complications. Methods: We present a series of 8 patients in which a submental flap was performed to restore cutaneous defects of the middle and lower thirds of the face, and the treatment of secondary lymphedema of the upper extremity. Flaps dimensions were between 40 to 84 cm2 (average of 62 cm2). The flap was designed as submental pedicled flap in 4 cases (50%), with preservation of digastric muscle based on a submental perforator in 2 cases, reverse flow submental flap in 1 case, and as a vascularized submental lymph node transfer flap y 1 case. Results: Complications occurred in 1 of the cases, presented as a partial necrosis of a 30% of a submental reverse flow flap, which healed by secondary intention. Donor site was closed primarily in all the cases. Conclusions: In our opinion, the submental flap is a good choice for the coverage of cutaneous defects of the middle and lower face, providing a thickness, texture and color similar to neighboring tissues, as well as an alternative for the treatment of secondary lymphedema of the upper extremity


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Retalhos Cirúrgicos/cirurgia , Queixo/cirurgia , Carcinoma Basocelular/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Queixo/patologia , Anormalidades da Pele/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/secundário , Extremidade Superior/patologia , Extremidade Superior/cirurgia , Estudos Retrospectivos
16.
Plast Reconstr Surg ; 144(5): 1214-1224, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688769

RESUMO

BACKGROUND: Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive. METHODS: From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors' hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post-lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded. RESULTS: No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green-enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent). CONCLUSION: With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Microcirurgia/métodos , Veias/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , China , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Extremidade Inferior/cirurgia , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
17.
Clin Hemorheol Microcirc ; 73(1): 125-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561348

RESUMO

BACKGROUND: A physiological and minimal invasive form of surgery with minimal risk to treat lymphedemas is the so-called supermicrosurgical lymphovenous anastomosis (LVA) where a lymph vessel is connected with a venule. METHODS: 30 patients (between 2018 and 2019) with secondary upper extremity lymphedema refractory to conservative therapy (manual lymph drainage and compression therapy were operated using the "simplified lymphovenous anastomosis" method). For the assessment of lymphatic supermicrosurgery, an operating microscope in which a near-infrared illumination system is integrated (Leica M530 OHX with glow technology ULT530, Leica Microsystems) and the IC-FlowTM Imaging System(Diagnostic Green)/Visionsense System (Medtronic) together with a ZEISS S8 microscope was used. Augmented reality intraoperative indocyanin green (ICG) lymphography-navigated modified "simplified lymphovenous anastomosis" were performed on the Leica microscope. All patients were informed about Off-label-use of ICG lymphography. RESULTS: 57 LVAs were performed with modified "simplified lymphovenous anastomosis" lymphography-guidance on 30 upper extremities. All patients showed good patency after lymphovenous anastomosis. CONCLUSIONS: Supermicrosurgery in the case of LVA is minimally invasive, highly effective, and shows a very low complication rate. The surgeon/equipment-related factors restrict the pratice of LVA, and its effectiveness limited by technical constraints.


Assuntos
Anastomose Cirúrgica/métodos , Fluorescência , Verde de Indocianina/química , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Realidade Aumentada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Pan Afr Med J ; 33: 88, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489066

RESUMO

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.


Assuntos
Elefantíase/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Escroto/cirurgia , Elefantíase/patologia , Elefantíase/cirurgia , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Linfedema/patologia , Linfedema/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Marrocos , Escroto/diagnóstico por imagem , Escroto/patologia
19.
J Surg Oncol ; 120(6): 911-918, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376162

RESUMO

BACKGROUND: A new technique named "Selected Lymph Node" ("SeLyN") was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. METHODS: Bilateral lower-limb SPECT-CT was performed in the upper-limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor-site complications were recorded and lower-limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. RESULTS: A total of 41 patients underwent a "SeLyN" transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow-up period of 42.5 months. CONCLUSIONS: "SeLyN" is a safe and effective technique in selecting the most suitable LNs, minimizing the donor-site morbidity, and decreasing the overall operating time.


Assuntos
Neoplasias da Mama/cirurgia , Virilha/cirurgia , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Linfocintigrafia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Masculino , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
20.
BMC Med Imaging ; 19(1): 68, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420022

RESUMO

BACKGROUND: The aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap) transfer. METHODS: The head and neck regions of 20 patients with limb lymphedema were imaged using a 3 T MRI scanner. To improve the evaluation of facial artery courses, MRA was fused with anatomical structures generated by high-resolution T1-weighted imaging. The diagnostic and image qualities of facial arteries for VSLN flap planning were independently rated by two radiologists. Interobserver agreement was evaluated using Cohen's kappa. Differences between 3D PC-MRA and CE-MRA in terms of the diagnostic quality of facial arteries were evaluated using McNemar's test. RESULTS: Cohen's kappa indicated fair to good interobserver agreement for the diagnostic and image qualities of the bilateral facial arteries. No significant difference in terms of the diagnostic quality of the left and right facial arteries between 3D PC-MRA and CE-MRA, respectively, was identified. CONCLUSIONS: Non-contrast 3D PC-MRA is a reliable method for the evaluation of facial artery courses prior to VSLN flap transfer and could serve as an alternative to CE-MRA for patients with renal insufficiency or severe adverse reactions to contrast media.


Assuntos
Face/irrigação sanguínea , Linfonodos/irrigação sanguínea , Linfedema/diagnóstico por imagem , Angiografia por Ressonância Magnética/instrumentação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Face/diagnóstico por imagem , Feminino , Humanos , Linfonodos/cirurgia , Linfedema/cirurgia , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Período Pré-Operatório , Interpretação de Imagem Radiográfica Assistida por Computador , Retalhos Cirúrgicos , Adulto Jovem
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