The All but Forgotten Mascagni-Sappey Pathway: Learning from Immediate Lymphatic Reconstruction.
Adult
Aged
Anastomosis, Surgical
/ methods
Axilla
Axillary Vein
/ surgery
Breast Cancer Lymphedema
/ diagnosis
Breast Neoplasms
/ surgery
Coloring Agents
/ administration & dosage
Databases, Factual
Female
Fluorescein-5-isothiocyanate
/ administration & dosage
Humans
Lymph Node Excision
/ adverse effects
Lymphatic Vessels
/ anatomy & histology
Microsurgery
Middle Aged
Plastic Surgery Procedures
/ methods
Retrospective Studies
Rosaniline Dyes
/ administration & dosage
Upper Extremity
/ anatomy & histology
Journal
Journal of reconstructive microsurgery
ISSN: 1098-8947
Titre abrégé: J Reconstr Microsurg
Pays: United States
ID NLM: 8502670
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
pubmed:
10
8
2019
medline:
2
12
2020
entrez:
10
8
2019
Statut:
ppublish
Résumé
Upper extremity lymphedema occurs in 25 to 40% of patients after axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) or the lymphatic micro- surgical preventative healing approach has demonstrated a significant decrease in postoperative rates of lymphedema (LE) from 4 to 12%. Our objective was to map the Mascagni -Sappey pathway, the lateral upper arm draining lymphatics, in patients undergoing ILR to better characterize the drainage pattern of this lymphosome to the axilla. A retrospective review of our institutional lymphatic database was conducted and consecutive breast cancer patients undergoing ILR were identified from November 2017 through June 2018. Patient demographics, clinical characteristics, and intraoperative records were retrieved and analyzed. Twenty-nine consecutive breast cancer patients who underwent ILR after ALND were identified. Patients had a mean age of 54.6years and body mass index (BMI) of 26.6 kg/m2. Fluorescein isothiocyanate (FITC) was injected at the medial upper arm and isosulfan blue was injected at the cephalic vein, or lateral upper arm, prior to ALND. After ALND, an average 2.5 divided lymphatics were identified, and a mean 1.2 lymphatics were bypassed. In all patients, divided FITC lymphatics were identified. However, in only three patients (10%), divided blue lymphatics were identified after ALND. In this study, variable drainage of the lateral upper arm to the axillary bed was noted. This study is the first to provide a description of intraoperative findings, demonstrating variable drainage patterns of upper extremity lymphatics to the axilla. Moreover, we noted that the lateral- and medial-upper arm lymphosomes have mutually exclusive pathways draining to the axilla. Further study of lymphatic anatomy variability may elucidate the pathophysiology of lymphedema development and influence approaches to immediate lymphatic reconstruction.
Sections du résumé
BACKGROUND
BACKGROUND
Upper extremity lymphedema occurs in 25 to 40% of patients after axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) or the lymphatic micro- surgical preventative healing approach has demonstrated a significant decrease in postoperative rates of lymphedema (LE) from 4 to 12%. Our objective was to map the Mascagni -Sappey pathway, the lateral upper arm draining lymphatics, in patients undergoing ILR to better characterize the drainage pattern of this lymphosome to the axilla.
METHODS
METHODS
A retrospective review of our institutional lymphatic database was conducted and consecutive breast cancer patients undergoing ILR were identified from November 2017 through June 2018. Patient demographics, clinical characteristics, and intraoperative records were retrieved and analyzed.
RESULTS
RESULTS
Twenty-nine consecutive breast cancer patients who underwent ILR after ALND were identified. Patients had a mean age of 54.6years and body mass index (BMI) of 26.6 kg/m2. Fluorescein isothiocyanate (FITC) was injected at the medial upper arm and isosulfan blue was injected at the cephalic vein, or lateral upper arm, prior to ALND. After ALND, an average 2.5 divided lymphatics were identified, and a mean 1.2 lymphatics were bypassed. In all patients, divided FITC lymphatics were identified. However, in only three patients (10%), divided blue lymphatics were identified after ALND.
CONCLUSION
CONCLUSIONS
In this study, variable drainage of the lateral upper arm to the axillary bed was noted. This study is the first to provide a description of intraoperative findings, demonstrating variable drainage patterns of upper extremity lymphatics to the axilla. Moreover, we noted that the lateral- and medial-upper arm lymphosomes have mutually exclusive pathways draining to the axilla. Further study of lymphatic anatomy variability may elucidate the pathophysiology of lymphedema development and influence approaches to immediate lymphatic reconstruction.
Identifiants
pubmed: 31398762
doi: 10.1055/s-0039-1694757
doi:
Substances chimiques
Coloring Agents
0
Rosaniline Dyes
0
iso-sulfan blue
39N9K8S2A4
Fluorescein-5-isothiocyanate
I223NX31W9
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28-31Informations de copyright
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Déclaration de conflit d'intérêts
None declared.