Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Pedro Ciudad, Oscar J. Manrique, Kian Adabi, Tony Chieh Ting Huang, Mouchammed Agko, Emilio Trignano, Wei Ling Chang, Tsung Wei Chen, Christopher J. Salgado, Hung Chi Chen

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)439-448
Number of pages10
JournalJournal of Surgical Oncology
Volume119
Issue number4
DOIs
StatePublished - Mar 15 2019

Fingerprint

Lymphedema
Lymph Nodes
Quality of Life
Lymphoscintigraphy
Drainage
Hyperesthesia
Skin
Hypesthesia
Lymph
Quality Improvement
Upper Extremity
Lower Extremity
Extremities
Demography
Therapeutics
Infection

Keywords

  • advanced lymphedema
  • lymphaticovenous anastomosis
  • radical reduction with preservation of perforators
  • vascularized lymph node transfer

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema. / Ciudad, Pedro; Manrique, Oscar J.; Adabi, Kian; Huang, Tony Chieh Ting; Agko, Mouchammed; Trignano, Emilio; Chang, Wei Ling; Chen, Tsung Wei; Salgado, Christopher J.; Chen, Hung Chi.

In: Journal of Surgical Oncology, Vol. 119, No. 4, 15.03.2019, p. 439-448.

Research output: Contribution to journalArticle

Ciudad, P, Manrique, OJ, Adabi, K, Huang, TCT, Agko, M, Trignano, E, Chang, WL, Chen, TW, Salgado, CJ & Chen, HC 2019, 'Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema', Journal of Surgical Oncology, vol. 119, no. 4, pp. 439-448. https://doi.org/10.1002/jso.25360
Ciudad, Pedro ; Manrique, Oscar J. ; Adabi, Kian ; Huang, Tony Chieh Ting ; Agko, Mouchammed ; Trignano, Emilio ; Chang, Wei Ling ; Chen, Tsung Wei ; Salgado, Christopher J. ; Chen, Hung Chi. / Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema. In: Journal of Surgical Oncology. 2019 ; Vol. 119, No. 4. pp. 439-448.
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AU - Ciudad, Pedro

AU - Manrique, Oscar J.

AU - Adabi, Kian

AU - Huang, Tony Chieh Ting

AU - Agko, Mouchammed

AU - Trignano, Emilio

AU - Chang, Wei Ling

AU - Chen, Tsung Wei

AU - Salgado, Christopher J.

AU - Chen, Hung Chi

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N2 - 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.

AB - 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.

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