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.

Analysis of the Risk Factors of Upper Limb Lymphedema after Breast Cancer Surgery and Nursing Care

Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients from October 2017 to December 2020 were selected,all patients underwent surgical intervention,retrospectively analyzed the basic clinical data of patients,and statistically analyzed the influencing factors of upper limb lymphedema.All patients with upper extremity lymphedema received high-quality nursing intervention,and the specific nursing effect was analyzed.Results:Logistic regression analysis showed that the risk factors of upper limb lymphedema after breast cancer surgery included hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and so on.After nursing intervention,the patients*12*5 elbow 10cm,elbow 10cm,wrist size value and VAS score were better than those before nursing(P<0.05).The quality of life score of patients after nursing intervention was significantly better than that before nursing(P<0.05).Conclusion:Hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and other factors can induce upper limb lymphedema after breast cancer surgery.Effective nursing intervention can alleviate the condition of patients with upper limb lymphedema and improve their quality of life,which is worthy of comprehensive promotion.