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Distally Based Lymphatic Microsurgical Preventive Healing Approach-A Modification of the Classic Approach.

Allen Wei-Jiat Wong^1,2, Nadia Hui Shan Sim¹, Coeway Boulder Thing¹

¹Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore.

Archives of Plastic Surgery

|September 30, 2024

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This summary is machine-generated.

Distally based Lymphatic Microsurgical Preventive Healing Approach (dLYMPHA) reduces breast cancer-related lymphedema (BCRL) risk. This modified technique offers improved surgical ergonomics and vessel matching compared to traditional methods.

Area of Science:

Oncology
Microsurgery
Lymphedema Management

Background:

Breast cancer treatment advances have increased survivorship, highlighting the need to manage functional and aesthetic outcomes.
Breast cancer-related lymphedema (BCRL) remains a significant post-treatment complication.
Immediate lymphatic reconstruction aims to prevent BCRL, with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) being a key technique.

Purpose of the Study:

To introduce and evaluate a modified, distally based LYMPHA (dLYMPHA) technique for BCRL prevention.
To address the limitations of traditional LYMPHA, including recipient vessel identification, vessel size mismatch, high axillary venous pressure, and surgical ergonomics.
To compare the incidence of BCRL in patients undergoing dLYMPHA versus standard care.

Main Methods:

Keywords:

breast cancer lymphedema lymphovenous anastomosis microsurgery

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A retrospective analysis of 113 patients undergoing mastectomy with axillary clearance (2018-2021).
Group 1 (n=87) did not undergo lymphatic reconstruction.
Group 2 (n=26) underwent the modified distally based LYMPHA (dLYMPHA) procedure.

Main Results:

BCRL incidence was 17.2% in the standard care group (Group 1) versus 3.84% in the dLYMPHA group (Group 2) (p=0.018).
dLYMPHA facilitated reliable identification of suitable lymphatics and venules in the distal upper limb with better size matching.
The distal modification resulted in a more favorable lymphaticovenular pressure gradient and improved surgical ergonomics.

Conclusions:

Distally based LYMPHA (dLYMPHA) is an effective modification for preventing BCRL.
The dLYMPHA technique overcomes the limitations of traditional LYMPHA by utilizing more accessible vessels and improving surgical conditions.
dLYMPHA offers a promising approach to reduce BCRL incidence with comparable safety and improved surgical feasibility.