Scar lymphedema : Fact or fiction?
Identifieur interne : 007733 ( Main/Exploration ); précédent : 007732; suivant : 007734Scar lymphedema : Fact or fiction?
Auteurs : Anne G. Warren [États-Unis] ; Sumner A. Slavin [États-Unis]Source :
- Annals of plastic surgery [ 0148-7043 ] ; 2007.
Descripteurs français
- KwdFr :
- MESH :
- épidémiologie : Cicatrice, Lymphoedème.
- Pascal (Inist)
English descriptors
- KwdEn :
- MESH :
- epidemiology : Cicatrix, Lymphedema.
- surgery : Lymphedema.
- Abdominal Wall, Adolescent, Adult, Aged, Face, Female, Humans, Male, Middle Aged, Reoperation, Thoracic Wall.
Abstract
Background: Few concepts are as fundamental to plastic surgery as scarring, yet swelling within a scar and its adjacent tissues is a common observation which is not well understood. Mechanical forces, scar contracture, fibrosis, and lymph stasis have been considered as possible explanations for these edematous-appearing areas, but conclusive evidence of a cause of swelling has not been established. The purpose of this study was to evaluate the possible role of microlymphatic stasis or disruption as a causal factor. Patients and Methods: Eleven patients (mean age: 43; range: 15 to 70) with localized swelling in conjunction with linear or curvilinear scars were evaluated, 9 with facial scars and 2 with scars of the chest wall and abdomen. Swelling within the scar had been present for an average of 4.5 years (range: 9 months to 13 years). Two patients had undergone previous Z-plasty revisions to the limbs of their curvilinear scars. Radiocolloid lymphoscintigraphy with technetium-99m Sb2S3 was performed on all patients by single or multiple injection technique into the site of the scar corresponding to local edema. Results: Following injection, rapid egress of radiotracer was visualized along lymphatic pathways posterior to the scar, with continuation to locoregional nodes in all patients with U-shaped "trapdoor" or linear scar configuration. However, in 8 cases there was no evidence of lymphatic drainage traversing or bridging the scar. In 2 patients with multiple prior Z-plasty revisions to the limbs of curvilinear scars, no visualization of lymph channels across the Z-plasty flaps was apparent. In total, 8 patients were diagnosed with lymphedema of the area adjacent to or enclosed within the scar. Conclusions: These findings suggest that undrained lymphatic fluid contributes to the pathogenesis of the raised and swollen tissues seen abutting a U-shaped scar. Furthermore, as lymphatic pathways do not reestablish themselves across scars, attempts at improving lymphatic flow with Z-plasty revisions may not succeed in patients with clinical trapdoor scar deformities. Determination of scar lymphedema can assist in the selection of proper management for patients seeking scar revision.
Affiliations:
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Le document en format XML
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<term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Cicatrix (epidemiology)</term>
<term>Face</term>
<term>Female</term>
<term>Humans</term>
<term>Lymphedema</term>
<term>Lymphedema (epidemiology)</term>
<term>Lymphedema (surgery)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Plastic surgery</term>
<term>Reoperation</term>
<term>Scar</term>
<term>Thoracic Wall</term>
<term>Treatment</term>
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<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Cicatrice (épidémiologie)</term>
<term>Face</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lymphoedème ()</term>
<term>Lymphoedème (épidémiologie)</term>
<term>Mâle</term>
<term>Paroi abdominale</term>
<term>Paroi thoracique</term>
<term>Réintervention</term>
<term>Sujet âgé</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Cicatrix</term>
<term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Cicatrice</term>
<term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Abdominal Wall</term>
<term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Face</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Reoperation</term>
<term>Thoracic Wall</term>
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<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Face</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lymphoedème</term>
<term>Cicatrice</term>
<term>Chirurgie plastique</term>
<term>Mâle</term>
<term>Paroi abdominale</term>
<term>Paroi thoracique</term>
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<front><div type="abstract" xml:lang="en">Background: Few concepts are as fundamental to plastic surgery as scarring, yet swelling within a scar and its adjacent tissues is a common observation which is not well understood. Mechanical forces, scar contracture, fibrosis, and lymph stasis have been considered as possible explanations for these edematous-appearing areas, but conclusive evidence of a cause of swelling has not been established. The purpose of this study was to evaluate the possible role of microlymphatic stasis or disruption as a causal factor. Patients and Methods: Eleven patients (mean age: 43; range: 15 to 70) with localized swelling in conjunction with linear or curvilinear scars were evaluated, 9 with facial scars and 2 with scars of the chest wall and abdomen. Swelling within the scar had been present for an average of 4.5 years (range: 9 months to 13 years). Two patients had undergone previous Z-plasty revisions to the limbs of their curvilinear scars. Radiocolloid lymphoscintigraphy with technetium-99m Sb<sub>2</sub>
S<sub>3</sub>
was performed on all patients by single or multiple injection technique into the site of the scar corresponding to local edema. Results: Following injection, rapid egress of radiotracer was visualized along lymphatic pathways posterior to the scar, with continuation to locoregional nodes in all patients with U-shaped "trapdoor" or linear scar configuration. However, in 8 cases there was no evidence of lymphatic drainage traversing or bridging the scar. In 2 patients with multiple prior Z-plasty revisions to the limbs of curvilinear scars, no visualization of lymph channels across the Z-plasty flaps was apparent. In total, 8 patients were diagnosed with lymphedema of the area adjacent to or enclosed within the scar. Conclusions: These findings suggest that undrained lymphatic fluid contributes to the pathogenesis of the raised and swollen tissues seen abutting a U-shaped scar. Furthermore, as lymphatic pathways do not reestablish themselves across scars, attempts at improving lymphatic flow with Z-plasty revisions may not succeed in patients with clinical trapdoor scar deformities. Determination of scar lymphedema can assist in the selection of proper management for patients seeking scar revision.</div>
</front>
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