Complete lymph flow reconstruction: A free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis.
Identifieur interne : 001259 ( Main/Exploration ); précédent : 001258; suivant : 001260Complete lymph flow reconstruction: A free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis.
Auteurs : Takumi Yamamoto (chirurgien) [Japon] ; Hidehiko Yoshimatsu [Japon] ; Nana Yamamoto [Japon]Source :
- Journal of plastic, reconstructive & aesthetic surgery : JPRAS [ 1878-0539 ] ; 2016.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Aine, Anastomose chirurgicale (), Femelle, Humains, Lambeau perforant (), Lymphoedème (), Lymphoedème (diagnostic), Lymphoedème (étiologie), Lymphographie, Membre inférieur, Microchirurgie (), Noeuds lymphatiques (imagerie diagnostique), Noeuds lymphatiques (transplantation), Procédures de chirurgie reconstructive (), Résultat thérapeutique, Vaisseaux lymphatiques ().
- MESH :
- diagnostic : Lymphoedème.
- imagerie diagnostique : Noeuds lymphatiques.
- étiologie : Lymphoedème, Noeuds lymphatiques.
- Adulte d'âge moyen, Aine, Anastomose chirurgicale, Femelle, Humains, Lambeau perforant, Lymphoedème, Lymphographie, Membre inférieur, Microchirurgie, Procédures de chirurgie reconstructive, Résultat thérapeutique, Vaisseaux lymphatiques.
English descriptors
- KwdEn :
- Anastomosis, Surgical (methods), Female, Groin, Humans, Lower Extremity, Lymph Nodes (diagnostic imaging), Lymph Nodes (transplantation), Lymphatic Vessels (surgery), Lymphedema (diagnosis), Lymphedema (etiology), Lymphedema (surgery), Lymphography, Microsurgery (methods), Middle Aged, Perforator Flap (blood supply), Reconstructive Surgical Procedures (methods), Treatment Outcome.
- MESH :
- blood supply : Perforator Flap.
- diagnosis : Lymphedema.
- diagnostic imaging : Lymph Nodes.
- etiology : Lymphedema.
- methods : Anastomosis, Surgical, Microsurgery, Reconstructive Surgical Procedures.
- surgery : Lymphatic Vessels, Lymphedema.
- transplantation : Lymph Nodes.
- Female, Groin, Humans, Lower Extremity, Lymphography, Middle Aged, Treatment Outcome.
Abstract
Treatment of primary lower extremity lymphedema (LEL) is challenging, and lymph node transfer (LNT) can be a choice of treatment for progressive LEL. However, LNT has a risk of donor site lymphedema and possible lymph node (LN) sclerosis due to efferent lymphatic vessel (ELV) obstruction. Here, we report the first case of complete lymph flow reconstruction with true perforator LNT with efferent lymphaticolymphatic anastomosis (ELLA) for a patient with primary LEL and severe lymphosclerosis. A 49-year-old female suffered from primary progressive unilateral left LEL refractory to conservative treatments with frequent episodes of cellulitis. A true perforator LN flap was selectively harvested from the left lateral thoracic region under indocyanine green (ICG) lymphography navigation and transferred to the left groin with perforator-to-perforator anastomosis. The ELV of the transplanted LN was supermicrosurgically anastomosed to the contralateral iliac lymphatic vessel that was subcutaneously transferred to the left groin. Postoperatively, the patient experienced no episode of cellulitis with reduced degree of compression treatment, and lymphedematous volume decreased from 306 to 264 in terms of LEL index. Postoperative ICG lymphography showed evidence of reconstructed lymph flow from the left foot to the left groin and to the right inguinal LN through the transplanted LN flap and the ELLA. There were no subjective or objective findings of donor site lymphedema of the left arm or the right back and the lower extremity. True perforator LN flap with ELLA is a safe and effective treatment and has the potential to be a useful therapeutic option for primary unilateral LEL.
DOI: 10.1016/j.bjps.2016.06.028
PubMed: 27449876
Affiliations:
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Le document en format XML
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Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Yamamoto, Nana" sort="Yamamoto, Nana" uniqKey="Yamamoto N" first="Nana" last="Yamamoto">Nana Yamamoto</name><affiliation wicri:level="3"><nlm:affiliation>Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author></analytic><series><title 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()</term><term>Femelle</term><term>Humains</term><term>Lambeau perforant ()</term><term>Lymphoedème ()</term><term>Lymphoedème (diagnostic)</term><term>Lymphoedème (étiologie)</term><term>Lymphographie</term><term>Membre inférieur</term><term>Microchirurgie ()</term><term>Noeuds lymphatiques (imagerie diagnostique)</term><term>Noeuds lymphatiques (transplantation)</term><term>Procédures de chirurgie reconstructive ()</term><term>Résultat thérapeutique</term><term>Vaisseaux lymphatiques ()</term></keywords><keywords scheme="MESH" qualifier="blood supply" xml:lang="en"><term>Perforator Flap</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Noeuds lymphatiques</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Anastomosis, Surgical</term><term>Microsurgery</term><term>Reconstructive Surgical Procedures</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lymphatic Vessels</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="transplantation" xml:lang="en"><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term><term>Noeuds lymphatiques</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Female</term><term>Groin</term><term>Humans</term><term>Lower Extremity</term><term>Lymphography</term><term>Middle Aged</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Aine</term><term>Anastomose chirurgicale</term><term>Femelle</term><term>Humains</term><term>Lambeau perforant</term><term>Lymphoedème</term><term>Lymphographie</term><term>Membre inférieur</term><term>Microchirurgie</term><term>Procédures de chirurgie reconstructive</term><term>Résultat thérapeutique</term><term>Vaisseaux lymphatiques</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Treatment of primary lower extremity lymphedema (LEL) is challenging, and lymph node transfer (LNT) can be a choice of treatment for progressive LEL. However, LNT has a risk of donor site lymphedema and possible lymph node (LN) sclerosis due to efferent lymphatic vessel (ELV) obstruction. Here, we report the first case of complete lymph flow reconstruction with true perforator LNT with efferent lymphaticolymphatic anastomosis (ELLA) for a patient with primary LEL and severe lymphosclerosis. A 49-year-old female suffered from primary progressive unilateral left LEL refractory to conservative treatments with frequent episodes of cellulitis. A true perforator LN flap was selectively harvested from the left lateral thoracic region under indocyanine green (ICG) lymphography navigation and transferred to the left groin with perforator-to-perforator anastomosis. The ELV of the transplanted LN was supermicrosurgically anastomosed to the contralateral iliac lymphatic vessel that was subcutaneously transferred to the left groin. Postoperatively, the patient experienced no episode of cellulitis with reduced degree of compression treatment, and lymphedematous volume decreased from 306 to 264 in terms of LEL index. Postoperative ICG lymphography showed evidence of reconstructed lymph flow from the left foot to the left groin and to the right inguinal LN through the transplanted LN flap and the ELLA. There were no subjective or objective findings of donor site lymphedema of the left arm or the right back and the lower extremity. True perforator LN flap with ELLA is a safe and effective treatment and has the potential to be a useful therapeutic option for primary unilateral LEL.</div></front></TEI><affiliations><list><country><li>Japon</li></country><region><li>Région de Kantō</li></region><settlement><li>Tokyo</li></settlement><orgName><li>Université de Tokyo</li></orgName></list><tree><country name="Japon"><region name="Région de Kantō"><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto (chirurgien)</name></region><name sortKey="Yamamoto, Nana" sort="Yamamoto, Nana" uniqKey="Yamamoto N" first="Nana" last="Yamamoto">Nana Yamamoto</name><name sortKey="Yoshimatsu, Hidehiko" sort="Yoshimatsu, Hidehiko" uniqKey="Yoshimatsu H" first="Hidehiko" last="Yoshimatsu">Hidehiko Yoshimatsu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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