The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: Creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography.
Adult
Aged
Anastomosis, Surgical
Breast Neoplasms
/ therapy
Coloring Agents
Female
Forearm
/ surgery
Humans
Indocyanine Green
Lymph Nodes
/ diagnostic imaging
Lymphatic Vessels
/ surgery
Lymphedema
/ diagnostic imaging
Lymphography
/ methods
Microsurgery
/ methods
Middle Aged
Preoperative Care
/ methods
Retrospective Studies
Sclerosis
/ complications
Ultrasonography
Venules
/ surgery
Dynamic ultrasonography
Lymphaticovenular anastomosis
Lymphedema
Supermicrosurgery
Journal
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
07
04
2018
revised:
15
08
2018
accepted:
07
09
2018
pubmed:
8
10
2018
medline:
5
11
2019
entrez:
8
10
2018
Statut:
ppublish
Résumé
Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements. We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA. Placement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions"). Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014). Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
Sections du résumé
BACKGROUND
BACKGROUND
Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
METHODS
METHODS
We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA.
RESULTS
RESULTS
Placement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions"). Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014).
CONCLUSIONS
CONCLUSIONS
Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
Identifiants
pubmed: 30292697
pii: S1748-6815(18)30330-9
doi: 10.1016/j.bjps.2018.09.005
pii:
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
62-70Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.