The Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity

Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.

Surgical management of genital lymphoedema:experience and critical considerations from a tricenter study

Aim:Genital lymphoedema(GL)is a chronic and debilitating disease,which can severely affect the patient’s quality of life with significant socio-economic impact.Nowadays,no gold standard algorithm exists for GL from diagnosis to treatment.This study proposes our therapeutic flowchart based on the three senior consultants’experience in lymphatic surgery.Methods:A retrospective investigation was conducted on a prospectively maintained database(2018-2022).Inclusion criteria involved all patients who underwent surgical procedures for treating GL in three plastic surgery departments(Lausanne,Bari,and Genova).Outcomes were assessed in terms of oedema reduction,stage regression,and functional reported outcomes.Results:16 patients with GL were included:50%underwent debulking surgery,18.8%microsurgery,and 31.2%debulking+microsurgery.We recorded a significant regression of the GL stage:62.5%shifted from stage II/III to postoperative stage I.Similarly,we found an infection recurrency resolution in 50%,a scrotal oedema reduction in 62.5%,and a scrotal oedema resolution in 37.5%of the patients treated.While almost half of the patients(53.3%)with associated penile oedema described persistent postoperative penile oedema,only two patients complained of persistent lymphorrhea.Conclusion:According to our clinical experience,preoperative and postoperative physical functional therapy is always recommended.For stages I and IIA,after the failure of the conservative treatment,lymph-venous shunts and lymph node transplantation surgery are proposed at the early time.When GL is already diagnosed at stages IIB and III,the debulking surgery,together with functional procedures,represents our first approach.

Vascularized lymph node transfer with efferent lymphatico-lymphatic anastomosis for treatment of upper extremity lymphedema

Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis.We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator(SCIP)flap,including VLNT with efferent lymphatico-lymphatic anastomosis.A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap,which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area.The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique.Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap.Postoperatively,lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up.Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.

Supraclavicular lymph node transplant:a focus on technique

Physiologic surgical options,including vascularized lymph node transplant and lymphovenous bypass are becoming increasingly popular interventions for the treatment of lymphedema of both the upper and lower extremities.Many different lymph node donor sites have been described,including submental,lateral thoracic,superficial groin,supraclavicular,and various intraabdominal sites.This paper describes a step-by-step approach to the harvest of vascularized lymph nodes from the supraclavicular area,which is the preferred donor site for most patients with both upper and lower extremity lymphedema.