title: Radical reduction of upper extremity lymphedema with preservation of perforators.
abstract: Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia. At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy.
authors.affiliation: Department of Plastic Surgery, University Hospitals Cleveland/Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Salgado
authors.forename: Paolo
authors.initials: P
authors.lastname: Sassu
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.forename: Stefano
authors.initials: S
authors.lastname: Spanio di Spilimbergo
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008220:Lymphography; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D010808:Physical Examination; D011183:Postoperative Complications / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000534:rehabilitation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity