Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma.

BACKGROUND: In patients with melanoma, there is considerable concern about the clearance of clinically negative nodes, partly because of the unacceptable morbidity reported after regional lymphadenectomy. The advent of sentinel lymph node biopsies has allowed us to select those patients with positive sentinel lymph nodes for completion node dissections. The purpose of this article is to demonstrate that when complete lymph node dissection is indicated, it can be performed with a low risk of lymphedema using the fascia-preserving technique. STUDY
DESIGN: The records of 209 consecutive patients with melanoma who underwent fascia-preserving axillary (n = 116) or ilioinguinofemoral (n = 93) lymphadenectomy by a single surgeon between January 1984 and April 1998 were reviewed. In each operation, care was taken not to disrupt the muscle fascia at the site of lymphadenectomy.
RESULTS: In the fascia-preserving axillary group, there were 59 men and 47 women with mean age of 53 years (range 21 to 79 years). There were three recurrences (3%) outside the borders of dissection. Transient upper extremity edema (8%) resolved over a median of 5 months, and permanent upper extremity edema occurred in 5% of patients. In the ilioinguinofemoral group, there were 19 men and 37 women with a mean age of 52 years (range 21 to 88 years). There was one recurrence (2%) outside the borders of dissection. Transient lower extremity edema (48%) resolved over a median of 12 months, and permanent lower extremity edema occurred in 14% of patients.
CONCLUSIONS: Preservation of the muscle fascia during lymph node dissection results in a lower incidence of permanent edema, with no increased risk of recurrence.