Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
12
07
2019
revised:
20
08
2019
accepted:
23
08
2019
pubmed:
1
10
2019
medline:
28
4
2020
entrez:
1
10
2019
Statut:
ppublish
Résumé
Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG-VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema. All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG-VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1 year follow up through LYMQOL questionnaire. Sixteen patients met inclusion criteria. Mean follow up was 26.2 months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12 months of follow up, the mean CRR was 58.3% at BK level (p = .001*) and 43.4% at AK level (p < .04*). LYMQOL metrics showed significantly better scores in all domains. Patients with lower limb lymphedema can benefit from combined DG-VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.
Sections du résumé
BACKGROUND
BACKGROUND
Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG-VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema.
METHODS
METHODS
All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG-VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1 year follow up through LYMQOL questionnaire.
RESULTS
RESULTS
Sixteen patients met inclusion criteria. Mean follow up was 26.2 months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12 months of follow up, the mean CRR was 58.3% at BK level (p = .001*) and 43.4% at AK level (p < .04*). LYMQOL metrics showed significantly better scores in all domains.
CONCLUSIONS
CONCLUSIONS
Patients with lower limb lymphedema can benefit from combined DG-VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
679-687Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Althubaiti, G. A., Crosby, M. A., & Chang, D. W. (2013). Vascularized supraclavicular lymph node transfer for lower extremity lymphedema treatment. Plastic and Reconstructive Surgery, 131(1), 133e-135e. https://doi.org/10.1097/PRS.0b013e318272a1b4
Azuma, S., Yamamoto, T., & Koshima, I. (2013). Donor-site lymphatic function after microvascular lymph node transfer should be followed using indocyanine green Lymphography. Plastic and Reconstructive Surgery, 131(3), 443e-444e. https://doi.org/10.1097/PRS.0b013e31827c7194
Becker, C. (2016). Autologous lymph node transfers. Journal of Reconstructive Microsurgery, 32(1), 28-33. https://doi.org/10.1055/s-0035-1563393
Bolletta, A., Di Taranto, G., Chen, S. H., Elia, R., Amorosi, V., Chan, J. C., & Chen, H. C. (2019). Surgical treatment of Milroy disease. Journal of Surgical Oncology. [EPub ahead of print] https://doi.org/10.1002/jso.25583
Chang, E. I., Masià, J., & Smith, M. L. (2018). Combining autologous breast reconstruction and vascularized lymph node transfer. Seminars in Plastic Surgery, 32(1), 36-41. https://doi.org/10.1055/s-0038-1632402
Cheng, M.-H., Koshima, I., Chang, D. W., & Masia, J. (2017). The 5th world symposium for lymphedema surgery. Journal of Surgical Oncology, 115(1), 5. https://doi.org/10.1002/jso.24383
Ciudad, P., Kiranantawat, K., Sapountzis, S., Sze-Wei Yeo, M., Nicoli, F., Maruccia, M., … Chen, H. C. (2015). Right gastroepiploic lymph node flap. Microsurgery, 35(6), 496-497. https://doi.org/10.1002/micr.22344
Ciudad, P., Manrique, O. J., Date, S., Agko, M., Perez Coca, J. J., Chang, W. L., … Chen, H. C. (2017). Double gastroepiploic vascularized lymph node transfers to middle and distal limb for the treatment of lymphedema. Microsurgery, 37(7), 771-779. https://doi.org/10.1002/micr.30168
Ciudad, P., Manrique, O. J., Date, S., Sacak, B., Chang, W. L., Kiranantawat, K., … Chen, H. C. (2017). A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience. Journal of Surgical Oncology, 115(1), 37-42. https://doi.org/10.1002/jso.24349
Ciudad, P., Maruccia, M., Socas, J., Lee, M. H., Chung, K. P., Constantinescu, T., … Chen, H. C. (2017). The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes. Microsurgery, 37(3), 197-205. https://doi.org/10.1002/micr.22450
Di Taranto, G., Chen, S.-H., Elia, R., Bolletta, A., Amorosi, V., Sitpahul, N., & Chen, H. C. (2019). Free gastroepiploic lymph nodes and omentum flap for treatment of lower limb ulcers in severe lymphedema: Killing two birds with one stone. Journal of Surgical Oncology. [EPub ahead of print] https://doi.org/10.1002/jso.25581
Di Taranto, G., Elia, R., Amorosi, V., Alamouti, R., Sitpahul, N., Chan, J., & Chen, H. C. (2018). The difference in the caliber of efferent lymphatic vessels among various lymph node flaps. Journal of Surgical Oncology, 118(7), 1212-1213. https://doi.org/10.1002/jso.25257
Executive Committee. (2016). The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology, 49(4), 170-184.
Fukushima, T., Tsuji, T., Sano, Y., Miyata, C., Kamisako, M., Hohri, H., … Liu, M. (2017). Immediate effects of active exercise with compression therapy on lower-limb lymphedema. Supportive Care in Cancer, 25(8), 2603-2610. https://doi.org/10.1007/s00520-017-3671-2
Giudice, G., Robusto, F., Vestita, M., Annoscia, P., Elia, R., & Nacchiero, E. (2017). Single-stage excision and sentinel lymph node biopsy in cutaneous melanoma in selected patients: A retrospective case-control study. Melanoma Research, 27(6), 573-579. https://doi.org/10.1097/CMR.0000000000000370
Gould, D. J., Mehrara, B. J., Neligan, P., Cheng, M.-H., & Patel, K. M. (2018). Lymph node transplantation for the treatment of lymphedema. Journal of Surgical Oncology, 118(5), 736-742. https://doi.org/10.1002/jso.25180
Hayashi, A., Hayashi, N., Yoshimatsu, H., & Yamamoto, T. (2018). Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. Journal of Surgical Oncology, 117(2), 290-298. https://doi.org/10.1002/jso.24812
Howell, A. C., Gould, D. J., Mayfield, C., Samakar, K., Hassani, C., & Patel, K. M. (2018). Anatomical basis of the Gastroepiploic vascularized lymph node transfer: A radiographic evaluation using computed tomographic angiography. Plastic and Reconstructive Surgery, 142(4), 1046-1052. https://doi.org/10.1097/PRS.0000000000004772
Keeley, V., Crooks, S., Locke, J., Veigas, D., Riches, K., & Hilliam, R. (2010). A quality of life measure for limb lymphoedema (LYMQOL). Clinical Research, 5(1), 13.
Kung, T. A., Champaneria, M. C., Maki, J. H., & Neligan, P. C. (2017). Current concepts in the surgical management of lymphedema. Plastic and Reconstructive Surgery, 139(4), 1003e-1013e. https://doi.org/10.1097/PRS.0000000000003218
Lee, T. S., Morris, C. M., Czerniec, S. A., & Mangion, A. J. (2018). Does lymphedema severity affect quality of life? Simple question. Challenging answers. Lymphatic Research and Biology, 16(1), 85-91. https://doi.org/10.1089/lrb.2016.0049
Leuzzi, S., Maruccia, M., Elia, R., Annoscia, P., Vestita, M., Nacchiero, E., & Giudice, G. (2018). Lymphatic-venous anastomosis in a rat model: A novel exercise for microsurgical training. Journal of Surgical Oncology, 118, 936-940. https://doi.org/10.1002/jso.25234
Lin, C.-H., Ali, R., Chen, S.-C., Wallace, C., Chang, Y. C., Chen, H. C., & Cheng, M. H. (2009). Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plastic and Reconstructive Surgery, 123(4), 1265-1275. https://doi.org/10.1097/PRS.0b013e31819e6529
Maruccia, M., Elia, R., Ciudad, P., Nacchiero, E., Nicoli, F., Vestita, M., … Giudice, G. (2019). Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study. Journal of Plastic, Reconstructive & Aesthetic Surgery, 72, 892-901. https://doi.org/10.1016/j.bjps.2019.01.029
Maruccia, M., Pezzolla, A., Elia, R., Vestita, M., Nacchiero, E., & Giudice, G. (2018). Letter to the editor. Journal of Surgical Oncology, 117, 1344-1345. https://doi.org/10.1002/jso.24958
Masià, J., Pons, G., & Rodríguez-Bauzà, E. (2016). Barcelona lymphedema algorithm for surgical treatment in breast cancer-related lymphedema. Journal of Reconstructive Microsurgery, 32(5), 329-335. https://doi.org/10.1055/s-0036-1578814
McNeely, M. L., Campbell, K. L., Courneya, K. S., & Mackey, J. R. (2009). Effect of acute exercise on upper-limb volume inbreast cancer survivors: A pilot study. Physiotherapy Canada, 61(4), 244-251. https://dx.doi.org/10.3138/physio.61.4.244
Mercier, G., Pastor, J., Moffatt, C., Franks, P., & Quéré, I. (2019). LIMPRINT: Health-related quality of life in adult patients with chronic Edema. Lymphatic Research and Biology, 17(2), 163-167. https://doi.org/10.1089/lrb.2018.0084
Mihara, M., Hara, H., Furniss, D., Narushima, M., Iida, T., Kikuchi, K., … Murai, N. (2014). Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. The British Journal of Surgery, 101(11), 1391-1396. https://doi.org/10.1002/bjs.9588
Patel, K. M., Lin, C.-Y., & Cheng, M.-H. (2015). From theory to evidence: Long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers. Journal of Reconstructive Microsurgery, 31(1), 26-30 doi:10.1055/s-0034-1381957.
Pereira de Godoy, J. M., Braile, D. M., de Fátima Godoy, M., & Longo, O. (2002). Quality of life and peripheral lymphedema. Lymphology, 35(2), 72-75.
Schaverien, M. V., Badash, I., Patel, K. M., Selber, J. C., & Cheng, M.-H. (2018). Vascularized lymph node transfer for lymphedema. Seminars in Plastic Surgery, 32(1), 28-35. https://doi.org/10.1055/s-0038-1632401
Schirger, A., Martin, W. J., & Spittell, J. A. (1965). Acute lymphangitis and cellulitis. Diagnosis and therapy. Minnesota Medicine, 48, 191-194.
Sharkey, A. R., King, S. W., Ramsden, A. J., & Furniss, D. (2017). Do surgical interventions for limb lymphoedema reduce cellulitis attack frequency? Microsurgery, 37(4), 348-353. https://doi.org/10.1002/micr.30115
Shesol, B. F., Nakashima, R., Alavi, A., & Hamilton, R. W. (1979). Successful lymph node transplantation in rats, with restoration of lymphatic function. Plastic and Reconstructive Surgery, 63(6), 817-823.
Silva, A. K., & Chang, D. W. (2016). Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema. Journal of Surgical Oncology, 113(8), 932-939. https://doi.org/10.1002/jso.24171
Suma, H. (2013). Gastroepiploic artery graft in coronary artery bypass grafting. Annals of Cardiothoracic Surgery, 2(4), 493-498. https://doi.org/10.3978/j.issn.2225-319X.2013.06.04
Suma, H., Tanabe, H., Takahashi, A., Horii, T., Isomura, T., Hirose, H., & Amano, A. (2007). Twenty years experience with the gastroepiploic artery graft for CABG. Circulation, 116(11 Suppl), I188-I191. https://doi.org/10.1161/CIRCULATIONAHA.106.678813
Vignes, S. (2017). Lymphedema: From diagnosis to treatment. La Revue de Médecine Interne, 38(2), 97-105. https://doi.org/10.1016/j.revmed.2016.07.005
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296
Yamamoto, T. (2019). Impact of lower extremity dysmorphia on lymphedema patients' quality of life. Plastic and Reconstructive Surgery, 143, 896e-897e. https://doi.org/10.1097/PRS.0000000000005468
Yamamoto, T., Narushima, M., Yoshimatsu, H., Yamamoto, N., Oka, A., Seki, Y., … Koshima, I. (2013). Indocyanine green velocity: Lymph transportation capacity deterioration with progression of lymphedema. Annals of Plastic Surgery, 71(5), 591-594. https://doi.org/10.1097/SAP.0b013e318255168a