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Combined Surgical Treatment for Chronic Upper Extremity Lymphedema Patients: Simultaneous Lymph Node Transfer and
Ida-Maria Leppäpuska1, Erkki Suominen1, Tiina Viitanen1
1From the Departments of Plastic and General Surgery.
Annals of Plastic Surgery
|April 23, 2019
Summary
The combined technique of lymph node transfer and liposuction significantly reduces upper limb lymphedema volume and infections compared to lymph node transfer alone. This approach offers better outcomes for chronic lymphedema patients.
Area of Science:
- Plastic Surgery
- Lymphedema Management
- Microsurgery
Background:
- Upper limb lymphedema is a frequent complication following axillary lymph node dissection.
- Microvascular lymph node transfer improves lymphatic drainage, while liposuction reduces arm volume and adipose tissue.
- This study evaluates a combined surgical approach for chronic lymphedema.
Purpose of the Study:
- To compare the efficacy of simultaneous lymph node transfer and liposuction with lymph node transfer alone in treating chronic upper limb lymphedema.
- To assess improvements in arm volume, lymphatic function, and infection rates.
Main Methods:
- A retrospective observational study compared 21 patients undergoing combined lymph node transfer and liposuction with 27 patients undergoing lymph node transfer alone.
- Patients had chronic non-pitting lymphedema post-surgery or lymphoma.
- Outcomes measured included arm volume changes, lymphoscintigraphy transport indexes, erysipelas infections, and compression garment usage.
Main Results:
- The combined technique group showed an 87.7% average decrease in arm volume excess, significantly greater improvement in lymphoscintigraphy (P=0.01), and a significant reduction in erysipelas infections (P=0.02) compared to the lymph node transfer only group.
- In the combined group, 70% experienced no edema increase without compression, and 17/21 patients reduced compression garment use.
- The lymph node transfer only group had a 27.5% average decrease in arm volume excess, with 8/19 improving lymphoscintigraphy and 1/3 reducing infections.
Conclusions:
- Simultaneous lymph node transfer and liposuction is a safe and effective treatment for chronic lymphedema, providing immediate volume reduction and improved lymphatic function.
- The combined technique demonstrates superior outcomes in reducing lymphedema volume, improving lymphatic circulation, and decreasing infection rates.
- This combined approach may be particularly beneficial for patients with late-stage chronic lymphedema.
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