A novel two-stage surgical approach to treat chronic lymphedema.
Identifieur interne : 006763 ( Ncbi/Curation ); précédent : 006762; suivant : 006764A novel two-stage surgical approach to treat chronic lymphedema.
Auteurs : Jay W. Granzow [États-Unis] ; Julie M. Soderberg ; Christine DauphineSource :
- The breast journal [ 1524-4741 ]
Descripteurs français
- KwdFr :
- MESH :
- anatomopathologie : Tumeurs du sein.
- effets indésirables : Lymphadénectomie.
- Adulte d'âge moyen, Anastomose chirurgicale, Femelle, Humains, Lipectomie, Lymphoedème, Maladie chronique, Noeuds lymphatiques, Tumeurs du sein, Vaisseaux lymphatiques.
English descriptors
- KwdEn :
- MESH :
- adverse effects : Lymph Node Excision.
- methods : Anastomosis, Surgical, Lipectomy.
- pathology : Breast Neoplasms.
- surgery : Lymph Nodes, Lymphatic Vessels, Lymphedema.
- therapy : Breast Neoplasms.
- Chronic Disease, Female, Humans, Middle Aged.
Abstract
Surgical treatment of chronic lymphedema has seen significant advances. Suction-assisted protein lipectomy (SAPL) has been shown to safely and effectively reduce the solid component of swelling in chronic lymphedema. However, these patients must continuously use compression garments to control and prevent recurrence. Microsurgery procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have been shown to be effective in the management of the fluid component of lymphedema and allow for decreased garment use. SAPL and VLNT were applied together in a two-stage approach in two patients with chronic lymphedema after treatment for breast cancer. SAPL was used first to remove the chronic, solid component of the soft-tissue excess. Volume excess in our patients' arms was reduced an average of approximately 83% and 110% after SAPL surgery. After the arms had sufficiently healed and the volume reductions had stabilized, VLNT was performed to reduce the need for continuous compression and reduce fluid re-accumulation. Following the VLNT procedures, the patients were able to remove their compression garments consistently during the day and still maintain their volume reductions. Neither patient had any postoperative episodes of cellulitis. SAPL and VLNT can be combined to achieve optimal outcomes in patients with chronic lymphedema.
DOI: 10.1111/tbj.12282
PubMed: 24943048
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pubmed:24943048Le document en format XML
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<term>Breast Neoplasms (pathology)</term>
<term>Breast Neoplasms (therapy)</term>
<term>Chronic Disease</term>
<term>Female</term>
<term>Humans</term>
<term>Lipectomy (methods)</term>
<term>Lymph Node Excision (adverse effects)</term>
<term>Lymph Nodes (surgery)</term>
<term>Lymphatic Vessels (surgery)</term>
<term>Lymphedema (surgery)</term>
<term>Middle Aged</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Anastomose chirurgicale ()</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lipectomie ()</term>
<term>Lymphadénectomie (effets indésirables)</term>
<term>Lymphoedème ()</term>
<term>Maladie chronique</term>
<term>Noeuds lymphatiques ()</term>
<term>Tumeurs du sein ()</term>
<term>Tumeurs du sein (anatomopathologie)</term>
<term>Vaisseaux lymphatiques ()</term>
</keywords>
<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Tumeurs du sein</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Lymphadénectomie</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Anastomosis, Surgical</term>
<term>Lipectomy</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lymph Nodes</term>
<term>Lymphatic Vessels</term>
<term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Breast Neoplasms</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Chronic Disease</term>
<term>Female</term>
<term>Humans</term>
<term>Middle Aged</term>
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<term>Anastomose chirurgicale</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lipectomie</term>
<term>Lymphoedème</term>
<term>Maladie chronique</term>
<term>Noeuds lymphatiques</term>
<term>Tumeurs du sein</term>
<term>Vaisseaux lymphatiques</term>
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<front><div type="abstract" xml:lang="en">Surgical treatment of chronic lymphedema has seen significant advances. Suction-assisted protein lipectomy (SAPL) has been shown to safely and effectively reduce the solid component of swelling in chronic lymphedema. However, these patients must continuously use compression garments to control and prevent recurrence. Microsurgery procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have been shown to be effective in the management of the fluid component of lymphedema and allow for decreased garment use. SAPL and VLNT were applied together in a two-stage approach in two patients with chronic lymphedema after treatment for breast cancer. SAPL was used first to remove the chronic, solid component of the soft-tissue excess. Volume excess in our patients' arms was reduced an average of approximately 83% and 110% after SAPL surgery. After the arms had sufficiently healed and the volume reductions had stabilized, VLNT was performed to reduce the need for continuous compression and reduce fluid re-accumulation. Following the VLNT procedures, the patients were able to remove their compression garments consistently during the day and still maintain their volume reductions. Neither patient had any postoperative episodes of cellulitis. SAPL and VLNT can be combined to achieve optimal outcomes in patients with chronic lymphedema.</div>
</front>
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