Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema

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• 作者：Fabio Nicoli ; Joannis Constantinides ; Pedro Ciudad…
• 关键词：Breast cancer ; Breast cancer ; related lymphedema ; Laser ; Laser lipolysis ; Liposuction ; Lymphedema ; Lymph node ; Lymph node transfer ; Lymph node flap ; Lymph ; Lymphedema treatment ; Quality of life
• 刊名：Lasers in Medical Science
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：30
• 期：4
• 页码：1377-1385
• 全文大小：8,072 KB
• 参考文献：1.Cancer Facts & Figures (2011) American Cancer Society. Atlanta
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  18.Sapountzis S, Singhal D, Rashid A, Ciudad P, Meo D, Chen HC (2013) Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer. Ann Plast Surg
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• 作者单位：Fabio Nicoli (1) (2)
  Joannis Constantinides (1) (3)
  Pedro Ciudad (1)
  Stamatis Sapountzis (1)
  Kidakorn Kiranantawat (1) (4)
  Davide Lazzeri (5)
  Seong Yoon Lim (1)
  Marzia Nicoli (2) (5)
  Pei-Yu Chen (6)
  Matthew Sze-Wei Yeo (1)
  Ram M. Chilgar (1) (7)
  Hung-Chi Chen (1)
  
  1. Department of Plastic and Reconstructive Surgery, China Medical University Hospital, 2 Yuh-Der Road, 40447, Taichung, Taiwan
  2. Department of Plastic and Reconstructive Surgery, University of Rome “Tor Vergata- Rome, Italy
  3. Department of Plastic and Reconstructive Surgery, St. Thomas-Hospital, London, UK
  4. Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  5. Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, Italy
  6. Department of Pathology, China Medical University Hospital, Taichung, Taiwan
  7. Department of Plastic and Reconstructive Surgery, Maharashtra University of Health Sciences, Nashik, India
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Medicine/Public Health, general
  Dentistry
  Laser Technology and Physics and Photonics
  Quantum Optics, Quantum Electronics and Nonlinear Optics
  Applied Optics, Optoelectronics and Optical Devices
  
• 出版者：Springer London
• ISSN：1435-604X

文摘

Upper limb lymphedema following breast cancer surgery is a challenging problem for the surgeon. Lymphatico-venous or lymphatico-lymphatic anastomoses have been used to restore the continuity of the lymphatic system, offering a degree of improvement. Long-term review indicates that lumen obliteration and occlusion at the anastomosis level commonly occurs with time as a result of elevated venous pressure. Lymph node flap transfer is another microsurgical procedure designed to restore lymphatic system physiology but does not provide a complete volume reduction, particularly in the presence of hypertrophied adipose tissue and fibrosis, common in moderate and advanced lymphedema. Laser-assisted liposuction has been shown to effectively reduce fat and fibrotic tissues. We present preliminary results of our practice using a combination of lymph node flap transfer and laser-assisted liposuction. Between October 2012 and May 2013, ten patients (mean 54.6?±-.3?years) with moderate (stage II) upper extremity lymphedema underwent groin or supraclavicular lymph node flap transfer combined with laser-assisted liposuction (high-power diode pulsed laser with 1470-nm wavelength, LASEmaR 1500-EUFOTON, Trieste, Italy). A significant decrease of upper limb circumference measurements at all levels was noted postoperatively. Skin tonicity was improved in all patients. Postoperative lymphoscintigraphy revealed reduced lymph stasis. No patient suffered from donor site morbidity. Our results suggest that combining laser liposuction with lymph node flap transfer is a safe and reliable procedure, achieving a reduction of upper limb volume in treated patients suffering from moderate upper extremity lymphedema.