Pedro Ciudad1,2,3, Mouchammed Agko1, John Jaime Perez Coca1, Oscar J Manrique1, Wei-Ling Chang1, Fabio Nicoli1, Shih-Heng Chen4, Hung-Chi Chen1. 1. Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan. 2. Department of Biological Science and Technology, China Medical University, Taichung, Taiwan. 3. Peru Plastic and Reconstructive Surgery Research Institute, Lima, Peru. 4. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang-Gung University, Linkou, Taiwan.
Abstract
BACKGROUND: This study evaluated the long-term clinical outcomes among different vascularized lymph node transfers (VLNT) used at our institution. METHODS: Between July 2010 and July 2016, all patients with International Society of Lymphology (ISL) stages II-III who underwent VLNT were evaluated. Demographic and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) were recorded pre-operatively. Clinical outcomes, complications, and additional excisional procedures were analyzed post-operatively. At least 2-year follow-up was required for inclusion. RESULTS: Overall, 83 patients (Stage II:47, Stage III:36) met the inclusion criterion. Mean follow-up was 32.8 months (range, 24-49). Lymph node flaps used were groin (n = 13), supraclavicular (n = 25), gastroepiploic (n = 42), ileocecal (n = 2), and appendicular (n = 1). Total mean circumference reduction rate was 29.1% (Stage II) and 17.9% (Stage III) (P < 0.05). A paired t-test showed that VLNT significantly decreased the number of infections (P < 0.05). Three patients reported no improvement of the symptoms. Major complications included one flap loss and one donor site hematoma. After the period of follow-up, 18 patients (21.7%) underwent additional excisional procedures. CONCLUSION: VLNT is a promising technique used for the treatment of lymphedema and appears to be more effective in moderate stages (Stage II). Patients with advanced stage lymphedema (Stage III) may benefit from additional excisional procedures.
BACKGROUND: This study evaluated the long-term clinical outcomes among different vascularized lymph node transfers (VLNT) used at our institution. METHODS: Between July 2010 and July 2016, all patients with International Society of Lymphology (ISL) stages II-III who underwent VLNT were evaluated. Demographic and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) were recorded pre-operatively. Clinical outcomes, complications, and additional excisional procedures were analyzed post-operatively. At least 2-year follow-up was required for inclusion. RESULTS: Overall, 83 patients (Stage II:47, Stage III:36) met the inclusion criterion. Mean follow-up was 32.8 months (range, 24-49). Lymph node flaps used were groin (n = 13), supraclavicular (n = 25), gastroepiploic (n = 42), ileocecal (n = 2), and appendicular (n = 1). Total mean circumference reduction rate was 29.1% (Stage II) and 17.9% (Stage III) (P < 0.05). A paired t-test showed that VLNT significantly decreased the number of infections (P < 0.05). Three patients reported no improvement of the symptoms. Major complications included one flap loss and one donor site hematoma. After the period of follow-up, 18 patients (21.7%) underwent additional excisional procedures. CONCLUSION: VLNT is a promising technique used for the treatment of lymphedema and appears to be more effective in moderate stages (Stage II). Patients with advanced stage lymphedema (Stage III) may benefit from additional excisional procedures.
Authors: Oscar J Manrique; Samyd Said Bustos; Trishul Kapoor; Jason Lin; Pedro Ciudad; Antonio J Forte; Gabriel Del Corral; Maria Mani; Michele Maruccia; Andre Terzic Journal: Gland Surg Date: 2020-04
Authors: Pedro Ciudad; Antonio J Forte; Maria T Huayllani; Daniel Boczar; Oscar J Manrique; Samyd S Bustos; Atenas Bustamante; Hung-Chi Chen Journal: Gland Surg Date: 2020-04
Authors: Pedro Ciudad; Oscar J Manrique; Samyd S Bustos; Maria I Vargas; César Reynaga; Mouchammed Agko; Tony C T Huang; Eduardo Figueroa Benites; Horacio F Mayer; Antonio J Forte Journal: Gland Surg Date: 2020-04
Authors: Mark V Schaverien; Donald P Baumann; Jesse C Selber; Edward I Chang; Matthew M Hanasono; Carrie Chu; Summer E Hanson; Charles E Butler Journal: Plast Reconstr Surg Glob Open Date: 2020-03-20
Authors: Edward I Chang; Carrie K Chu; Summer E Hanson; Jesse C Selber; Matthew M Hanasono; Mark V Schaverien Journal: Plast Reconstr Surg Glob Open Date: 2020-03-27