Vascularized appendicular lymph node transfer for treatment of extremity lymphedema

A case report

Pedro Ciudad, Oscar J Manrique, Shivprasad Date, Wei-Ling Chang, Fabio Nicoli, Stamatis Sapountzis, Hsu-Tang Cheng, Mouchammed Agko, Hung-Chi Chen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Vascularized lymph node transfer has demonstrated promising results for the treatment of extremity lymphedema. In an attempt to find the ideal donor site, several vascularized lymph nodes have been described. Each has a common goal of decreasing morbidity and avoiding iatrogenic lymphedema while obtaining good clinical results. Herein, we present the preliminary clinical outcomes of an intra-abdominal lymph node flap option based on the appendicular artery and vein used for the treatment of extremity lymphedema. A 62 year-old woman with moderate lower extremity lymphedema, on chronic antibiotics because of recurrent infections and unsatisfactory outcomes after conservative treatment underwent a vascularized appendicular lymph node (VALN) transfer. At a follow-up of 6 months, the reduction rate of the limb circumference was 17.4%, 15.1%, 12.0% and 9% above the knee, below the knee, above the ankle and foot respectively. In addition, no further episodes of infection or other complications were reported after VALN transfer. Postoperative lymphoscintigraphy demonstrated that the VALN flap was able to improve the lymphatic drainage of the affected limb. According to our findings, the use of VALN transfer minimizes donor-site morbidity, avoids iatrogenic lymphedema and may provide a strong clearance of infection because of the strong immunologic properties of the appendiceal lymphatic tissue in selected patients. Despite these promising results, further research with larger number of patients and longer follow- up is needed.

Original languageEnglish (US)
JournalMicrosurgery
DOIs
StateE-pub ahead of print - Dec 2 2016
Externally publishedYes

Fingerprint

Lymphedema
Extremities
Lymph Nodes
Therapeutics
Knee
Infection
Tissue Donors
Lymphoscintigraphy
Morbidity
Lymphoid Tissue
Ankle
Foot
Drainage
Lower Extremity
Veins
Arteries
Anti-Bacterial Agents
Research

Cite this

Ciudad, P., Manrique, O. J., Date, S., Chang, W-L., Nicoli, F., Sapountzis, S., ... Chen, H-C. (2016). Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report. Microsurgery. https://doi.org/10.1002/micr.30134

Vascularized appendicular lymph node transfer for treatment of extremity lymphedema : A case report. / Ciudad, Pedro; Manrique, Oscar J; Date, Shivprasad; Chang, Wei-Ling; Nicoli, Fabio; Sapountzis, Stamatis; Cheng, Hsu-Tang; Agko, Mouchammed; Chen, Hung-Chi.

In: Microsurgery, 02.12.2016.

Research output: Contribution to journalArticle

Ciudad, P, Manrique, OJ, Date, S, Chang, W-L, Nicoli, F, Sapountzis, S, Cheng, H-T, Agko, M & Chen, H-C 2016, 'Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report', Microsurgery. https://doi.org/10.1002/micr.30134
Ciudad, Pedro ; Manrique, Oscar J ; Date, Shivprasad ; Chang, Wei-Ling ; Nicoli, Fabio ; Sapountzis, Stamatis ; Cheng, Hsu-Tang ; Agko, Mouchammed ; Chen, Hung-Chi. / Vascularized appendicular lymph node transfer for treatment of extremity lymphedema : A case report. In: Microsurgery. 2016.
@article{d9ff94b2ac4745cd8e28d13feb1bbb9b,
title = "Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report",
abstract = "Vascularized lymph node transfer has demonstrated promising results for the treatment of extremity lymphedema. In an attempt to find the ideal donor site, several vascularized lymph nodes have been described. Each has a common goal of decreasing morbidity and avoiding iatrogenic lymphedema while obtaining good clinical results. Herein, we present the preliminary clinical outcomes of an intra-abdominal lymph node flap option based on the appendicular artery and vein used for the treatment of extremity lymphedema. A 62 year-old woman with moderate lower extremity lymphedema, on chronic antibiotics because of recurrent infections and unsatisfactory outcomes after conservative treatment underwent a vascularized appendicular lymph node (VALN) transfer. At a follow-up of 6 months, the reduction rate of the limb circumference was 17.4{\%}, 15.1{\%}, 12.0{\%} and 9{\%} above the knee, below the knee, above the ankle and foot respectively. In addition, no further episodes of infection or other complications were reported after VALN transfer. Postoperative lymphoscintigraphy demonstrated that the VALN flap was able to improve the lymphatic drainage of the affected limb. According to our findings, the use of VALN transfer minimizes donor-site morbidity, avoids iatrogenic lymphedema and may provide a strong clearance of infection because of the strong immunologic properties of the appendiceal lymphatic tissue in selected patients. Despite these promising results, further research with larger number of patients and longer follow- up is needed.",
author = "Pedro Ciudad and Manrique, {Oscar J} and Shivprasad Date and Wei-Ling Chang and Fabio Nicoli and Stamatis Sapountzis and Hsu-Tang Cheng and Mouchammed Agko and Hung-Chi Chen",
note = "{\circledC} 2016 Wiley Periodicals, Inc.",
year = "2016",
month = "12",
day = "2",
doi = "10.1002/micr.30134",
language = "English (US)",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Vascularized appendicular lymph node transfer for treatment of extremity lymphedema

T2 - A case report

AU - Ciudad, Pedro

AU - Manrique, Oscar J

AU - Date, Shivprasad

AU - Chang, Wei-Ling

AU - Nicoli, Fabio

AU - Sapountzis, Stamatis

AU - Cheng, Hsu-Tang

AU - Agko, Mouchammed

AU - Chen, Hung-Chi

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2016/12/2

Y1 - 2016/12/2

N2 - Vascularized lymph node transfer has demonstrated promising results for the treatment of extremity lymphedema. In an attempt to find the ideal donor site, several vascularized lymph nodes have been described. Each has a common goal of decreasing morbidity and avoiding iatrogenic lymphedema while obtaining good clinical results. Herein, we present the preliminary clinical outcomes of an intra-abdominal lymph node flap option based on the appendicular artery and vein used for the treatment of extremity lymphedema. A 62 year-old woman with moderate lower extremity lymphedema, on chronic antibiotics because of recurrent infections and unsatisfactory outcomes after conservative treatment underwent a vascularized appendicular lymph node (VALN) transfer. At a follow-up of 6 months, the reduction rate of the limb circumference was 17.4%, 15.1%, 12.0% and 9% above the knee, below the knee, above the ankle and foot respectively. In addition, no further episodes of infection or other complications were reported after VALN transfer. Postoperative lymphoscintigraphy demonstrated that the VALN flap was able to improve the lymphatic drainage of the affected limb. According to our findings, the use of VALN transfer minimizes donor-site morbidity, avoids iatrogenic lymphedema and may provide a strong clearance of infection because of the strong immunologic properties of the appendiceal lymphatic tissue in selected patients. Despite these promising results, further research with larger number of patients and longer follow- up is needed.

AB - Vascularized lymph node transfer has demonstrated promising results for the treatment of extremity lymphedema. In an attempt to find the ideal donor site, several vascularized lymph nodes have been described. Each has a common goal of decreasing morbidity and avoiding iatrogenic lymphedema while obtaining good clinical results. Herein, we present the preliminary clinical outcomes of an intra-abdominal lymph node flap option based on the appendicular artery and vein used for the treatment of extremity lymphedema. A 62 year-old woman with moderate lower extremity lymphedema, on chronic antibiotics because of recurrent infections and unsatisfactory outcomes after conservative treatment underwent a vascularized appendicular lymph node (VALN) transfer. At a follow-up of 6 months, the reduction rate of the limb circumference was 17.4%, 15.1%, 12.0% and 9% above the knee, below the knee, above the ankle and foot respectively. In addition, no further episodes of infection or other complications were reported after VALN transfer. Postoperative lymphoscintigraphy demonstrated that the VALN flap was able to improve the lymphatic drainage of the affected limb. According to our findings, the use of VALN transfer minimizes donor-site morbidity, avoids iatrogenic lymphedema and may provide a strong clearance of infection because of the strong immunologic properties of the appendiceal lymphatic tissue in selected patients. Despite these promising results, further research with larger number of patients and longer follow- up is needed.

U2 - 10.1002/micr.30134

DO - 10.1002/micr.30134

M3 - Article

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

ER -