Microlymphatic bypass in obstructive lymphoedema

doi:10.1016/0007-1226(88)90003-3

British Journal of Plastic Surgery

Volume 41, Issue 5, September 1988, Pages 475-484

https://doi.org/10.1016/0007-1226(88)90003-3 Get rights and content

Abstract

A small series of patients with obstructive or secondary lymphoedema treated by microlymphatic bypass is presented. The procedures in the lower and upper limbs are described. Preoperative assessment by lymphangiography and lymphoscintigraphy are required to assess suitability for the procedure. Postoperatively, patent lymph collectors can be demonstrated by lymphoscintigraphy. Microlymphatic bypass must be carried out before the peripheral lymph collectors have been destroyed or permanently damaged by increasing back pressure and recurrent infection. Factors influencing a successful result are enumerated. Other microsurgical techniques and treatment are reviewed.

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Lymphatic reconstruction offers additional treatment options for the condition of secondary lymphedema especially if resistant to conservative therapy. Current options for surgical approaches as lymphaticovenular anastomosis, lymph node transfer, and lympholymphatic grafts with lymphovenular anastomosis represent the most popular methods for lymphatic reconstruction. Short-term and long-term follow-up results indicate significant improvements regarding lymphedema and the patient's quality of life. Nevertheless, in most cases, additional conservative therapy is recommended and required. Vascularized lymph node transfer could show beneficial short-term results, but until now, studies evaluating long-term efficacy are lacking for the full acceptance of this method for reconstructive surgery. Similarly, the use of lymphatic grafts could not offer convincing results for the application as an alternative method for lymphatic reconstruction. Further improvement of the aforementioned surgical techniques and a consensus in standardized protocols and reporting of outcome is finally needed to enhance and consolidate lymphatic reconstruction in secondary lymphedema.
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Would complex decongestive therapy reveal long term effect and lymphoscintigraphy predict the outcome of lower-limb lymphedema related to gynecologic cancer treatment?
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Citation Excerpt :
Lymphoscintigraphy offers objective evidence to distinguish lymphatic pathology from non-lymphatic causes of extremity edema [15–17]. Qualitative and quantitative lymphoscintigraphies has been widely used in the assessment of therapeutic interventions for lymphedema, ranging from microsurgery and liposuction to manual lymphatic massage, and pneumatic compression [18–22], and it may predict the outcome of lymphedema therapy. In a recent study of women undergoing therapy for post-mastectomy lymphedema, Szuba et al. found that the degree of lymphatic function impairment before treatment correlated with the outcome of manual lymphatic therapy [23].
The aims of this study were to investigate the long-term effect of complex decongestive therapy (CDT) on lymphedema volume reduction, especially considering the proximal and distal parts of the leg, and to evaluate the utility of pre-therapy lymphoscintigraphy in predicting the response to CDT in patients with lower-limb lymphedema after surgery for gynecologic cancer.
Medical records of 158 patients with secondary lymphedema of unilateral leg after surgery for gynecological cancer were reviewed retrospectively. They were treated with two weeks of CDT along with self-administered home therapy and were followed up for 24 months. Whole, proximal and distal leg volume was serially measured by using an optoelectric volumeter prior to and immediately after therapy, and follow-up visits at months 3, 6, 12 and 24. Lymphoscintigraphy was performed prior to therapy.
The percent volume reduction was 22.1% in the whole leg, 30.9% in the distal leg and 18.4% in the proximal leg immediately after CDT. The volume reduction was maintained for 24 months, but the distal leg was significantly well maintained better than the proximal leg. Extremity radioisotope uptake ratio (EUR) among lymphoscintigraphic findings could predict the improvement of lymphedema volume in the distal, proximal and whole leg.
This study suggests that the long-term edema reducing effects of CDT are better maintained in the distal leg than in the proximal part, and initial lymphoscintigraphic quantitative finding may usefully predict the short and long-term response to CDT.
Understanding breast cancer-related lymphoedema
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Breast cancer-related lymphoedema (BCRL) is a chronic swelling of the upper limb following surgery to axillary lymph nodes. This clinical literature review considers the risk factors that have been identified for the development of BCRL: the extent of surgery to the breast and the axilla, radiotherapy, nodal status, infection and patient characteristics such as BMI and patient age. The management of BCRL is primarily conservative, but the evidence for pharmacological and surgical approaches is also considered.
The usefulness of isotopic lymphoscintigraphy in the study of lymphedemas
2005, Actas Dermo-Sifiliograficas
El linfedema es un proceso causado por la obstrucción o la destrucción de los vasos linfáticos en el tejido subcutáneo. Esta debilitante enfermedad se diagnostica erróneamente con frecuencia y un diagnóstico y un tratamiento precoces pueden mejorar el curso clínico de aquélla.
Destacar la importancia de la linfogammagrafía isotópica como técnica sencilla y no invasiva para la valoración y diagnóstico de linfedemas.
Presentamos 2 pacientes afectados de edema genital y otro con edema en extremidad superior derecha. Todos ellos fueron secundarios a infecciones crónicas. Se realizó una linfogammagrafía isotópica a los 3 pacientes.
En los 3 pacientes la linfografía isotópica permitió confirmar el diagnóstico y la extensión del linfedema.
Creemos que a todos los pacientes con linfedema se les deberían realizar técnicas como flebografías, ecografía-Doppler, tomografía computarizada (TC), resonancia magnética (RM), cultivos y biopsias con el fin de poder establecer la causa de aquél. Proponemos que la linfogammagrafía isotópica se añada a estas pruebas para un adecuado manejo de los linfedemas.
Lymphedema is a process caused by the obstruction or destruction of the lymphatic vessels in the subcutaneous tissue. Early diagnosis and treatment can improve its clinical course, but this debilitating disease is often misdiagnosed.
To highlight the importance of isotopic lymphoscintigraphy as a simple, non-invasive technique for the assessment and diagnosis of lymphedemas.
We present 2 patients affected with genital edema, and another with edema in the right upper limb. All of these were secondary to chronic infections. An isotopic lymphoscintigraphy was performed on all three patients.
In all three patients, the isotopic lymphoscintigraphy made it possible to confirm the diagnosis and the extent of the lymphedema.
We believe that techniques such as phlebography, ultrasound/Doppler, CAT, magnetic resonance, cultures and biopsies should be used with all lymphedema patients in order to establish the cause of the disease. We propose that isotopic lymphoscintigraphy be added to these tests for appropriate lymphedema management.

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Microlymphatic bypass in obstructive lymphoedema

Abstract

British Journal of Plastic Surgery

British Journal of Plastic Surgery

British Journal of Plastic Surgery

British Journal of Plastic Surgery

Mikrochirurgie des Lymphgefa¨ss-systems

Chirurg

Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphoedema

World Journal of Surgery