Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema
Corresponding Author
Pedro Ciudad MD, PhD
Department of Plastic and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
Department of Plastic and Reconstructive Surgery, National Cancer Institute of Peru (INEN), Lima, Peru
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Correspondence Pedro Ciudad, MD, PhD, Department of Plastic Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 40447, Taiwan. Email: [email protected]
Search for more papers by this authorOscar J Manrique MD
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorKian Adabi BA
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorTony Chieh-Ting Huang MD
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorMouchammed Agko MD
Department of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
Search for more papers by this authorEmilio Trignano MD, PhD
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorWei-Ling Chang BS
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorTsung-Wei Chen MD
Department of Pathology, China Medical University, Taichung, Taiwan
Search for more papers by this authorChristopher J. Salgado MD
Division of Plastic, Reconstructive and Aesthetic Surgery, University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorHung-Chi Chen MD, PhD
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorCorresponding Author
Pedro Ciudad MD, PhD
Department of Plastic and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
Department of Plastic and Reconstructive Surgery, National Cancer Institute of Peru (INEN), Lima, Peru
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Correspondence Pedro Ciudad, MD, PhD, Department of Plastic Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 40447, Taiwan. Email: [email protected]
Search for more papers by this authorOscar J Manrique MD
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorKian Adabi BA
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorTony Chieh-Ting Huang MD
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Search for more papers by this authorMouchammed Agko MD
Department of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
Search for more papers by this authorEmilio Trignano MD, PhD
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorWei-Ling Chang BS
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorTsung-Wei Chen MD
Department of Pathology, China Medical University, Taichung, Taiwan
Search for more papers by this authorChristopher J. Salgado MD
Division of Plastic, Reconstructive and Aesthetic Surgery, University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorHung-Chi Chen MD, PhD
Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan
Search for more papers by this authorAbstract
Background
Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals.
Methods
Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed.
Results
All flaps survived. The mean follow-up period was 14.2 months (range, 12-19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7-fold quality-of-life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases.
Conclusion
Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients’ quality of life in the advanced stages of lymphedema.
Supporting Information
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