Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 410
Filtrar
1.
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
2.
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
3.
Acta Cir Bras ; 34(9): e201900903, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778525

RESUMO

PURPOSE: To investigate the effect of mesenteric lymph drainage on the spleen injury and the expressions of inflammatory cytokines in splenic tissue in mice following hemorrhagic shock. METHODS: Male C57 mice were randomly divided into the sham shock, shock and shock+drainage groups. The mice in both shock and shock+drainage groups suffered femoral artery bleeding, maintained mean arterial pressure (MAP) of 40±2 mmHg for 90 min, and were resuscitated. And mesenteric lymph drainage was performed in the shock+drainage group at the time of resuscitation. After three hours of resuscitation, the splenic tissues were harvested for the histological observation and protein and mRNA expression analysis of cytokines. RESULTS: The spleen in the shock group revealed a significantly structural damage and increased mRNA expressions of MyD88 and TRAF6 and protein expressions of TIPE2, MyD88, TRIF and TRAF3 compared to the sham group. By contrast, the splenic pathological injury in the shock+drainage group was alleviated significantly, and the mRNA and protein expressions of TIPE2, MyD88, TRIF, TRAF3 and TRAF6 were significantly lower than those in the shock group. CONCLUSION: These results indicate that post-hemorrhagic shock mesenteric lymph drainage alleviates hemorrhagic shock-induced spleen injury and the expressions of inflammatory cytokines.


Assuntos
Inflamação/prevenção & controle , Vasos Linfáticos/cirurgia , Mesentério , Choque Hemorrágico/complicações , Baço/lesões , Animais , Modelos Animais de Doenças , Drenagem/métodos , Inflamação/etiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ressuscitação
4.
Plast Reconstr Surg ; 144(5): 751e-759e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688749

RESUMO

BACKGROUND: The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema. METHODS: Economics were modeled for a patient with breast cancer-related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass. Costs were retrieved from supplier price lists, physician fee schedules, lymphedema therapists, and literature reviews. The net present value of all costs incurred for each clinical pathway were calculated. RESULTS: The estimated net present value of all costs for a patient with breast cancer-related lymphedema undergoing treatment were as follows: (1) complete decongestive therapy alone ($30,400); (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy ($15,000); or (3) lymphovenous bypass requiring ongoing complete decongestive therapy ($42,100). The expected net present value of all costs for lymphovenous bypass was $26,800, which was comparable to that of complete decongestive therapy alone. Sensitivity analysis demonstrated that the expected net present value of lymphovenous bypass was dependent on the patient's life expectancy, number of bypass anastomoses, and likelihood of discontinuing complete decongestive therapy. CONCLUSIONS: Lymphedema has substantial ongoing costs irrespective of the treatment modality. The cost of lymphovenous bypass appears comparable to that of complete decongestive therapy alone-the surgical costs of lymphovenous bypass are offset by the savings from discontinued ongoing therapy. Despite its limitations as a theoretical economic model, this study provides insight into the potential economic impact of lymphovenous bypass.


Assuntos
Linfedema Relacionado a Câncer de Mama/economia , Linfedema Relacionado a Câncer de Mama/cirurgia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Excisão de Linfonodo/economia , Mastectomia/efeitos adversos , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/métodos , Linfedema Relacionado a Câncer de Mama/fisiopatologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Canadá , Estudos de Coortes , Drenagem/economia , Drenagem/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Vasos Linfáticos/cirurgia , Mastectomia/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia
5.
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
6.
Medicine (Baltimore) ; 98(43): e17575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651860

RESUMO

RATIONALE: Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA). PATIENT CONCERNS: We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies. DIAGNOSIS: The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema. INTERVENTIONS: LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm. OUTCOMES: Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required. LESSONS: LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.


Assuntos
Quilotórax/congênito , Vasos Linfáticos/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica/métodos , Quilotórax/cirurgia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Cavidade Pleural/cirurgia
7.
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 , 57943 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
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
10.
Plast Reconstr Surg ; 144(3): 738-758, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461041

RESUMO

Lymphedema affects up to 250 million people worldwide. The understanding of the pathophysiology of the condition, however, is incomplete and a cure remains elusive. A growing body of evidence supports the effectiveness of modern surgical techniques in ameliorating the long-term disability and functional impairment inflicted by lymphedema on the lives of those affected. These procedures can be broadly categorized as physiologic, including lymphovenous bypass and using a vascularized lymph node transplant; or de bulking, by suction-assisted lipectomy or direct excisional procedures. The lymphovenous bypass procedure involves identification of obstructed lymphatic vessels and targeted bypass of these into neighboring venules. The vascularized lymph node transplant procedure involves microvascular anastomosis of functional lymph nodes into an extremity, either to an anatomical (orthotopic) or nonanatomical (heterotopic) location, to restore physiologic lymphatic function. In patients undergoing postmastectomy breast reconstruction, this may be performed by transferring a deep inferior epigastric artery perforator flap with a chimeric groin lymph node flap. For patients that have undergone breast-conserving surgery, in those for whom a free abdominal flap is contraindicated, or for those with lymphedema affecting the lower extremity, many other vascularized lymph node transplant options are available; these include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, or from within the abdominal cavity. Chronic lymphedema is characterized by fibroadipose soft-tissue deposition that can only be removed by lipectomy, either minimally invasively using liposuction, or by direct excision. This article reviews the techniques and outcomes of surgical procedures used to treat lymphedema.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Lipectomia/métodos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Axila , Neoplasias da Mama/cirurgia , Doença Crônica/terapia , Feminino , Retalhos de Tecido Biológico/transplante , Virilha , Humanos , Linfonodos/irrigação sanguínea , Linfedema/diagnóstico , Linfedema/etiologia , Mastectomia/efeitos adversos , Seleção de Pacientes , Retalho Perfurante/transplante
11.
Plast Reconstr Surg ; 144(2): 486-496, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348365

RESUMO

BACKGROUND: Lymphovenous anastomosis is technically challenging and can be successfully performed with an advanced operating microscope, supermicrosurgical instruments, and indocyanine green lymphography. This study compared the outcomes between side-to-end and end-to-end lymphovenous anastomosis configurations for unilateral extremity lymphedema. METHODS: Between April of 2013 and June of 2017, lymphovenous anastomosis was indicated for 58 patients who preoperatively had patent lymphatic ducts by indocyanine green lymphography, including 20 patients with upper limb lymphedema and 38 patients with lower limb lymphedema. Either an end-to-end or a side-to-end lymphovenous anastomosis was used to anastomose the subdermal venule to the lymphatic duct. The circumferential difference and episodes of cellulitis were used as outcome measurements. RESULTS: Twenty-three patients underwent an end-to-end lymphovenous anastomosis and 35 patients underwent side-to-end lymphovenous anastomosis. All patients had an immediate patency evaluated by indocyanine green lymphography and patent blue assessments. All patients returned to their daily routine without the use of any compression garments. At an average follow-up of 16.5 months (range, 13.4 to 19.6 months), the improvement of circumferential difference (3.2 percent; range, 1.8 to 4.6 percent) in the side-to-end group was statistically greater than that in the end-to-end group (2.2 percent; range, 1 to 3.4 percent; p = 0.04). The overall episodes of cellulitis were significantly reduced from 1.7 times/year (range, 1.3 to 2.1 times/year) to 0.7 times/year (range, 0.3 to 1.1 times/year; p < 0.001), but no difference was observed between the two groups. CONCLUSIONS: Both side-to-end and end-to-end lymphovenous anastomosis configurations were effective surgical approaches for improving early-grade extremity lymphedema. Side-to-end lymphovenous anastomosis has the advantages of having greater efficacy for lymph drainage, requiring only one anastomosis and eliminating the need to use compression garments. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Microcirurgia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Anastomose Cirúrgica , Distribuição de Qui-Quadrado , China , Estudos de Coortes , Feminino , Humanos , Extremidade Inferior/cirurgia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfografia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Extremidade Superior/cirurgia , Grau de Desobstrução Vascular/fisiologia
12.
Handchir Mikrochir Plast Chir ; 51(6): 424-433, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31067594

RESUMO

Secondary lymphedema is a complex and devastating disease including chronic inflammation and reduced immunofunction, lymphatic fluid and protein accumulation due to misdirected lymphatic transport, and secondary fat deposition followed by fibrosis. While the domain of treatment still is lifelong complex decongestive therapy, it is more and more widespread to treat the disease with a surgical focus on physiologic, reconstructive strategies or debulking surgery. Lymphovenous Anastomosis (LVA) and Vascularized lymph node transplantation (VLNT) are the mostly frequently applied, reconstructive techniques which address restoration or improvement of physiologic lymph clearance. The article summarizes and discusses the recommendations of an expert panel on the diagnostic, indication and therapy of LVA and VLNT in secondary lymphedema during the 40th Meeting of the Germanspeaking Society of Microsurgery in Lugano, Switzerland, 2018. The expert panel addressed the basic diagnostics prior to lymphoreconstructive surgery, including the inevitable application of Indocyanine Green (ICG) based fluorescence lymphangiography and navigation for both techniques including reverse mapping to reduce the rate of donor-site lymphedema for VLNT as well as the use of lymphedema-specific quality of life questionnaires. Both LVA and VLNT are elaborately described, including tips and tricks on identifying functional lymphatic collectors, equipment, types of anastomosis and documentation for LVA and choice of donor and recipient site, number of includable lymph nodes and management of specific donor sites, e. g. jejunal mesenteric for VLNT. The synchronous and sequential application of LVA, VLNT and/or ablative liposuction is discussed against the background of the effectivity and morbidity of both reconstructive, physiologic techniques. Finally, recommendations on post-operative treatment and diagnostics are discussed. The present consensus paper intends to improve the level of standardization for further multicenter studies in the germanspeaking countries in this aspiring field of lymphedema treatment.


Assuntos
Anastomose Cirúrgica , Vasos Linfáticos/cirurgia , Linfedema , Microcirurgia , Consenso , Humanos , Linfonodos , Linfedema/cirurgia , Qualidade de Vida , Suíça
13.
J Surg Oncol ; 120(2): 160-167, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31144329

RESUMO

BACKGROUND: A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB). METHODS: A retrospective analysis of a prospective database was performed evaluating patients with breast cancer who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed. RESULTS: LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow-up of 11.8 months. CONCLUSION: We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.


Assuntos
Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/prevenção & controle , Adulto , Idoso , Axila , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Corantes , Feminino , Humanos , Verde de Indocianina , Linfedema/etiologia , Linfografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
J Plast Reconstr Aesthet Surg ; 72(6): 884-891, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30944074

RESUMO

BACKGROUND: Lymphaticovenous anastomosis (LVA) is a surgical treatment for lymphedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years because of the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advancement in lymphedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning. METHODS: A prospective study between April 2010 and June 2015 was conducted in 82 patients (77 females, mean age 45.5 years) with stage I (9.8%), II (73.2%), and III (17.0%) lymphedema. All patients underwent lymphedema surgical treatment with LVA. Surgery was planned based on preoperative information from ICG- L and MRL. RESULTS: We obtained a mean of 6.87 lymphatic locations per extremity from MRL and selected a mean of 4.04 for LVA. When MRL data coincided with ICG-L data, we found a functional lymphatic vessel in 96.9% of cases and performed LVA successfully in 91.4%. CONCLUSIONS: ICG-L and MRL are noninvasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach of surgical treatment of lymphedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective, and rational surgery.


Assuntos
Anastomose Cirúrgica/métodos , Vasos Linfáticos , Linfedema , Linfografia/métodos , Imagem por Ressonância Magnética/métodos , Veias/cirurgia , Corantes/farmacologia , Feminino , Humanos , Aumento da Imagem/métodos , Verde de Indocianina/farmacologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/fisiopatologia , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/fisiopatologia , Linfedema/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Resultado do Tratamento
17.
Microsurgery ; 39(4): 360-363, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30891819

RESUMO

Men, as well as women may develop breast lymphedema following breast cancer treatment. Microsurgically performed lymphovenous anastomosis (LVA), an effective treatment for lymphedema of the extremities, has also been successfully applied to breast lymphedema. Here we report the first case of breast lymphedema secondary to male breast cancer, treated with supermicrosurgical LVA. A 48-year-old man presented with breast lymphedema following mastectomy, axillary lymph node dissection, and adjuvant radiotherapy. After the oncological treatments, the patient reported a sensation of tension, pain, and swelling of the left breast. The diagnosis of breast lymphedema was confirmed by lymphoscintigraphy. Since conservative treatment with manual lymphdrainage was ineffective, we performed LVAs at the left breast region. In total, two lymph vessels were anastomosed to two nearby veins. Immediately following this intervention, the left breast and lateral thorax region decreased in size and the sensation of tension disappeared. One year postoperative there was no recurrence of the swelling and the patient was very satisfied with the result. Although more reports are needed to confirm its efficacy, supermicrosurgical LVA appears to be a valuable treatment option for breast lymphedema in both women and men.


Assuntos
Anastomose Cirúrgica/métodos , Neoplasias da Mama Masculina/cirurgia , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Microcirurgia/métodos , Complicações Pós-Operatórias/cirurgia , Veias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Plast Reconstr Surg ; 143(3): 558e-564e, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30817659

RESUMO

BACKGROUND: Lymphatic malformation is a congenital lymphatic disorder. Although a few lymphangiographic and lymphoscintigraphic studies of lymphatic malformation exist, its lymphatic flow has not been fully assessed, and a classification system has not yet been established. However, indocyanine green lymphography has been developed to safely provide a fine assessment of lymph flow in the treatment of lymphedema. In addition, indocyanine green lymphography has been shown to be helpful in detecting the lymphatic malformation inflow for the treatment of refractory microcystic type lymphatic malformation using the venous anastomosis technique. Therefore, the authors aimed to reveal the in vivo lymph flow around the lymphatic malformation using indocyanine green lymphography, and to design a classification system according to the observed patterns. METHODS: Indocyanine green lymphography was performed in 20 sequential pediatric patients with lymphatic malformation (aged 11 months to 10 years). Most of the cases were intractable, with microcystic or mixed-type lymphatic malformation. RESULTS: All patients successfully completed lymphography with clear observations. The flow patterns were classified into four types: type 1 had a strong detectable inflow; type 2 had multiple small observable inflows; type 3 had a superficial lymph flow over the lesion; and type 4 had a flow around the lymphatic malformation, without any connections to the lesion. CONCLUSION: The proposed classification system may aid in the further development of surgical treatments for lymphatic malformation.


Assuntos
Corantes Fluorescentes/administração & dosagem , Anormalidades Linfáticas/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Imagem Óptica/métodos , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Lactente , Anormalidades Linfáticas/cirurgia , Vasos Linfáticos/anormalidades , Vasos Linfáticos/cirurgia , Masculino , Veias/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA