Pedro Ciudad1,2,3, Oscar J Manrique4, Kian Adabi4, Tony Chieh-Ting Huang4, Mouchammed Agko5, Emilio Trignano3, Wei-Ling Chang3, Tsung-Wei Chen6, Christopher J Salgado7, Hung-Chi Chen3. 1. Department of Plastic and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru. 2. Department of Plastic and Reconstructive Surgery, National Cancer Institute of Peru (INEN), Lima, Peru. 3. Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan. 4. Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota. 5. Department of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia. 6. Department of Pathology, China Medical University, Taichung, Taiwan. 7. Division of Plastic, Reconstructive and Aesthetic Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Abstract
BACKGROUND: Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals. METHODS: Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed. RESULTS: All flaps survived. The mean follow-up period was 14.2 months (range, 12-19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7-fold quality-of-life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases. CONCLUSION: Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients' quality of life in the advanced stages of lymphedema.
BACKGROUND: Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals. METHODS: Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed. RESULTS: All flaps survived. The mean follow-up period was 14.2 months (range, 12-19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7-fold quality-of-life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases. CONCLUSION: Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients' quality of life in the advanced stages of lymphedema.
Authors: Pedro Ciudad; Oscar J Manrique; Samyd S Bustos; Mouchammed Agko; Tony Chieh-Ting Huang; Luis Vizcarra; Marco Lazo Nuñez; Federico Lo Torto; Antonio J Forte Journal: Gland Surg Date: 2020-04
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: Nicholas R Jarvis; Ricardo A Torres; Francisco R Avila; Antonio J Forte; Alanna M Rebecca; Chad M Teven Journal: Cancer Rep (Hoboken) Date: 2021-04-07
Authors: Patrick A Will; Zhenzhen Wan; Svenja E Seide; Juan Enrique Berner; Ulrich Kneser; Emre Gazyakan; Christoph Hirche Journal: Syst Rev Date: 2022-02-01