Yukio Seki1, Akiyoshi Kajikawa2, Takumi Yamamoto2, Takayuki Takeuchi3, Takahiro Terashima4, Norimitsu Kurogi4. 1. Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, 118-1 Nurumizu, Atsugi, Kanagawa 243-8551, Japan. Electronic address: yukioseki.pla@gmail.com. 2. Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. 3. Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, 118-1 Nurumizu, Atsugi, Kanagawa 243-8551, Japan. 4. Department of General Surgery, Shonan Atsugi Hospital, 118-1 Nurumizu, Atsugi, Kanagawa 243-8551, Japan.
Abstract
BACKGROUND: Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements. METHODS: We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA. RESULTS: Placement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions"). Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014). CONCLUSIONS: Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
BACKGROUND:Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements. METHODS: We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA. RESULTS: Placement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions"). Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014). CONCLUSIONS: Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
Authors: Joost A G N Wolfs; Luuke G E H de Joode; René R W J van der Hulst; Shan S Qiu Journal: Breast Cancer Res Treat Date: 2019-09-21 Impact factor: 4.872