Suitable therapy options for sub-clinical and early-stage lymphoedema patients.
BACKGROUND
The best therapeutic approach for patients with sub-clinical lymphoedema and symptomatic early-stage lymphoedema has not been determined yet.


METHODS
The prognosis of lymphatic function after lymphadenectomy for gynaecological cancer was observed in a cohort study of 192 lower limbs. Lymphatic function was evaluated by indocyanine green lymphography. Splash patterns were examined to determine if patients with this pattern tended to progress to symptomatic lymphoedema, and the efficacy of the compression therapy was also investigated. We also investigated the efficacy of lymphaticovenular anastomosis (LVA) in patients who exhibited a stardust pattern.


RESULTS
Patients with splash patterns on lymphography may progress to symptomatic lymphoedema with a significantly higher frequency compared with the others, with a relative ratio of 1.62. Compression therapy did not slow the progression of patients with splash patterns to stardust patterns. LVA for the patients who had recently shown stardust patterns eliminated the need for compression therapy in 44.8% of patients.


CONCLUSIONS
Patients with splash patterns should be followed up carefully for sub-clinical lymphoedema. However, there is no method to completely prevent these patients from developing stardust patterns associated with symptomatic lymphoedema. When patients become symptomatic, their lymphatic function may be improved by LVA. However, the limited effectiveness of this procedure should be clearly explained to patients before surgery.
Department of Plastic and Reconstructive Surgery, Chiba Cancer Center, Chiba City, Japan. Electronic address: shinsukeakitaprs@gmail.com.
Shinsuke
S
Akita
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Nobuyuki
N
Mitsukawa
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Nankoku City, Japan.
Motone
M
Kuriyama
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Masakazu
M
Hasegawa
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Yoshitaka
Y
Kubota
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Hideki
H
Tokumoto
Department of Plastic and Reconstructive Surgery, Chiba Cancer Center, Chiba City, Japan.
Tatsuya
T
Ishigaki
Clinical Research Center, Chiba University Hospital, Chiba City, Japan.
Hideki
H
Hanaoka
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Kaneshige
K
Satoh
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004396:Coloring Agents; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D035002:Lower Extremity; D008197:Lymph Node Excision / Q000009:adverse effects*; D042601:Lymphatic Vessels / Q000601:surgery; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008220:Lymphography; D008875:Middle Aged; D011379:Prognosis; D014680:Veins / Q000601:surgery
D004396:Coloring Agents; D007208:Indocyanine Green
Early-stage lymphoedema; Indocyanine green lymphography; Lymphaticovenular anastomosis; Sub-clinical lymphoedema