Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection
Identifieur interne : 000588 ( Pmc/Curation ); précédent : 000587; suivant : 000589Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection
Auteurs : Kyung Hoon Cook [Corée du Sud] ; Myong Chul Park [Corée du Sud] ; Il Jae Lee [Corée du Sud] ; Seong Yoon Lim [Corée du Sud] ; Yong Sik Jung [Corée du Sud]Source :
- Journal of Breast Cancer [ 1738-6756 ] ; 2016.
Abstract
Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.
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DOI: 10.4048/jbc.2016.19.1.92
PubMed: 27064862
PubMed Central: 4822114
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Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Il Jae" sort="Lee, Il Jae" uniqKey="Lee I" first="Il Jae" last="Lee">Il Jae Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Lim, Seong Yoon" sort="Lim, Seong Yoon" uniqKey="Lim S" first="Seong Yoon" last="Lim">Seong Yoon Lim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Jung, Yong Sik" sort="Jung, Yong Sik" uniqKey="Jung Y" first="Yong Sik" last="Jung">Yong Sik Jung</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27064862</idno><idno type="pmc">4822114</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822114</idno><idno type="RBID">PMC:4822114</idno><idno type="doi">10.4048/jbc.2016.19.1.92</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000588</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000588</idno><idno type="wicri:Area/Pmc/Curation">000588</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000588</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection</title><author><name sortKey="Cook, Kyung Hoon" sort="Cook, Kyung Hoon" uniqKey="Cook K" first="Kyung Hoon" last="Cook">Kyung Hoon Cook</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Park, Myong Chul" sort="Park, Myong Chul" uniqKey="Park M" first="Myong Chul" last="Park">Myong Chul Park</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Il Jae" sort="Lee, Il Jae" uniqKey="Lee I" first="Il Jae" last="Lee">Il Jae Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Lim, Seong Yoon" sort="Lim, Seong Yoon" uniqKey="Lim S" first="Seong Yoon" last="Lim">Seong Yoon Lim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author><author><name sortKey="Jung, Yong Sik" sort="Jung, Yong Sik" uniqKey="Jung Y" first="Yong Sik" last="Jung">Yong Sik Jung</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea></affiliation></author></analytic><series><title level="j">Journal of Breast Cancer</title><idno type="ISSN">1738-6756</idno><idno type="eISSN">2092-9900</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Murdaca, G" uniqKey="Murdaca G">G Murdaca</name></author><author><name sortKey="Cagnati, P" uniqKey="Cagnati P">P Cagnati</name></author><author><name sortKey="Gulli, R" uniqKey="Gulli R">R Gulli</name></author><author><name sortKey="Span, F" uniqKey="Span F">F Spanò</name></author><author><name sortKey="Puppo, F" uniqKey="Puppo F">F Puppo</name></author><author><name sortKey="Campisi, C" uniqKey="Campisi C">C Campisi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Karri, V" uniqKey="Karri V">V Karri</name></author><author><name sortKey="Yang, Mc" uniqKey="Yang M">MC Yang</name></author><author><name sortKey="Lee, Ij" uniqKey="Lee I">IJ Lee</name></author><author><name sortKey="Chen, Sh" uniqKey="Chen S">SH Chen</name></author><author><name sortKey="Hong, Jp" uniqKey="Hong J">JP Hong</name></author><author><name sortKey="Xu, Es" uniqKey="Xu E">ES Xu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sapountzis, S" uniqKey="Sapountzis S">S Sapountzis</name></author><author><name sortKey="Ciudad, P" uniqKey="Ciudad P">P Ciudad</name></author><author><name sortKey="Lim, Sy" uniqKey="Lim S">SY Lim</name></author><author><name sortKey="Chilgar, Rm" uniqKey="Chilgar R">RM Chilgar</name></author><author><name sortKey="Kiranantawat, K" uniqKey="Kiranantawat K">K Kiranantawat</name></author><author><name sortKey="Nicoli, F" uniqKey="Nicoli F">F Nicoli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Brien, Bm" uniqKey="O Brien B">BM O'Brien</name></author><author><name sortKey="Khazanchi, Rk" uniqKey="Khazanchi R">RK Khazanchi</name></author><author><name sortKey="Kumar, Pa" uniqKey="Kumar P">PA Kumar</name></author><author><name sortKey="Dvir, E" uniqKey="Dvir E">E Dvir</name></author><author><name sortKey="Pederson, Wc" uniqKey="Pederson W">WC Pederson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Granzow, Jw" uniqKey="Granzow J">JW Granzow</name></author><author><name sortKey="Soderberg, Jm" uniqKey="Soderberg J">JM Soderberg</name></author><author><name sortKey="Kaji, Ah" uniqKey="Kaji A">AH Kaji</name></author><author><name sortKey="Dauphine, C" uniqKey="Dauphine C">C Dauphine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chang, Dw" uniqKey="Chang D">DW Chang</name></author><author><name sortKey="Kim, S" uniqKey="Kim S">S Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Granzow, Jw" uniqKey="Granzow J">JW Granzow</name></author><author><name sortKey="Soderberg, Jm" uniqKey="Soderberg J">JM Soderberg</name></author><author><name sortKey="Dauphine, C" uniqKey="Dauphine C">C Dauphine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cheng, Mh" uniqKey="Cheng M">MH Cheng</name></author><author><name sortKey="Chen, Sc" uniqKey="Chen S">SC Chen</name></author><author><name sortKey="Henry, Sl" uniqKey="Henry S">SL Henry</name></author><author><name sortKey="Tan, Bk" uniqKey="Tan B">BK Tan</name></author><author><name sortKey="Lin, Mc" uniqKey="Lin M">MC Lin</name></author><author><name sortKey="Huang, Jj" uniqKey="Huang J">JJ Huang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lin, Ch" uniqKey="Lin C">CH Lin</name></author><author><name sortKey="Ali, R" uniqKey="Ali R">R Ali</name></author><author><name sortKey="Chen, Sc" uniqKey="Chen S">SC Chen</name></author><author><name sortKey="Wallace, C" uniqKey="Wallace C">C Wallace</name></author><author><name sortKey="Chang, Yc" uniqKey="Chang Y">YC Chang</name></author><author><name sortKey="Chen, Hc" uniqKey="Chen H">HC Chen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Breast Cancer</journal-id><journal-id journal-id-type="iso-abbrev">J Breast Cancer</journal-id><journal-id journal-id-type="publisher-id">JBC</journal-id><journal-title-group><journal-title>Journal of Breast Cancer</journal-title></journal-title-group><issn pub-type="ppub">1738-6756</issn><issn pub-type="epub">2092-9900</issn><publisher><publisher-name>Korean Breast Cancer Society</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27064862</article-id><article-id pub-id-type="pmc">4822114</article-id><article-id pub-id-type="doi">10.4048/jbc.2016.19.1.92</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cook</surname><given-names>Kyung Hoon</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Park</surname><given-names>Myong Chul</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Lee</surname><given-names>Il Jae</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Lim</surname><given-names>Seong Yoon</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Jung</surname><given-names>Yong Sik</given-names></name><xref ref-type="aff" rid="A2">1</xref></contrib></contrib-group><aff id="A1">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</aff><aff id="A2"><label>1</label>Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</aff><author-notes><corresp>Correspondence to: Il Jae Lee. Department of Plastic and Reconstructive Surgery, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5614, Fax: +82-31-219-5610, <email>i00325@live.co.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>25</day><month>3</month><year>2016</year></pub-date><volume>19</volume><issue>1</issue><fpage>92</fpage><lpage>95</lpage><history><date date-type="received"><day>09</day><month>4</month><year>2015</year></date><date date-type="accepted"><day>17</day><month>7</month><year>2015</year></date></history><permissions><copyright-statement>© 2016 Korean Breast Cancer Society. All rights reserved.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.</p></abstract><kwd-group><kwd>Breast neoplasms</kwd><kwd>Lipectomy</kwd><kwd>Lymphedema</kwd><kwd>Mastectomy</kwd><kwd>Vascularized composite allotransplantation</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Figure 1</label><caption><title>Preoperative evaluation and postoperative 1-year evaluation. (A) Preoperative status before vascularized lymph node transfer. (B) Postoperative 1-year evaluation.</title></caption><graphic xlink:href="jbc-19-92-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Figure 2</label><caption><title>Lymphoscintigraphy evaluation. (A) Preoperative evaluation which seen in dermal back flow of right forearm. (B) Postoperative 1-year image shows increased lymphatic uptake in wrist area and reduced dermal back flow.</title></caption><graphic xlink:href="jbc-19-92-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Figure 3</label><caption><title>Flap elevation and anastomosis. (A) Preoperative surgical design on donor site of right cervical area. (B) Recipient design on right forearm area. (C) Anastomosis procedure of transverse cervical artery based lymph node flap. (D) Immediate postoperative state.</title></caption><graphic xlink:href="jbc-19-92-g003"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Clinical data of upper extremity circumferences during staged operations</title></caption><alternatives><graphic xlink:href="jbc-19-92-i001"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="2" colspan="1">Location</th><th valign="middle" align="center" rowspan="2" colspan="1">Unaffected side (left) (cm)</th><th valign="middle" align="center" rowspan="1" colspan="4">Affected side (right) (cm)</th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">Preop</th><th valign="middle" align="center" rowspan="1" colspan="1">Postliposuction</th><th valign="middle" align="center" rowspan="1" colspan="1">Post-VLNT</th><th valign="middle" align="center" rowspan="1" colspan="1">Post 1-year</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Wrist</td><td valign="top" align="left" rowspan="1" colspan="1">16.5</td><td valign="top" align="left" rowspan="1" colspan="1">17</td><td valign="top" align="left" rowspan="1" colspan="1">16</td><td valign="top" align="left" rowspan="1" colspan="1">20</td><td valign="top" align="left" rowspan="1" colspan="1">19</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">10 cm distal from the cubital fossa</td><td valign="top" align="left" rowspan="1" colspan="1">22</td><td valign="top" align="left" rowspan="1" colspan="1">30</td><td valign="top" align="left" rowspan="1" colspan="1">26 (-50%<sup>*</sup>)</td><td valign="top" align="left" rowspan="1" colspan="1">21</td><td valign="top" align="left" rowspan="1" colspan="1">26 (-50%)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Cubital fossa</td><td valign="top" align="left" rowspan="1" colspan="1">24.5</td><td valign="top" align="left" rowspan="1" colspan="1">31.5</td><td valign="top" align="left" rowspan="1" colspan="1">29 (-35.7%)</td><td valign="top" align="left" rowspan="1" colspan="1">24.5</td><td valign="top" align="left" rowspan="1" colspan="1">28 (-50%)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">10 cm proximal from cubital fossa</td><td valign="top" align="left" rowspan="1" colspan="1">27</td><td valign="top" align="left" rowspan="1" colspan="1">35</td><td valign="top" align="left" rowspan="1" colspan="1">30 (-62.5%)</td><td valign="top" align="left" rowspan="1" colspan="1">26</td><td valign="top" align="left" rowspan="1" colspan="1">30 (-62.5%)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Axillary area</td><td valign="top" align="left" rowspan="1" colspan="1">32</td><td valign="top" align="left" rowspan="1" colspan="1">33</td><td valign="top" align="left" rowspan="1" colspan="1">32 (-100%)</td><td valign="top" align="left" rowspan="1" colspan="1">31</td><td valign="top" align="left" rowspan="1" colspan="1">31 (-200%)</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p>VLNT=vascularized lymph node transfer.</p><p><sup>*</sup>%=[Preoperative circumferences-postoperative (liposuction or VLNT) circumferences/Preoperative circumferences-unaffected side circumferences]×100.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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