title: Lymphedema of the upper limb: evaluation of the functional outcome by dynamic imaging of lymph kinetics after autologous lymph vessel transplantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate by lymphoscintigraphy the functional outcome after autologous lymph vessel transplantation (Tx) of the upper limb.
  
  
  METHODS
  One hundred seventy-seven patients (172 female, 5 male; median age, 56 years; range, 12-84 years) presenting with Tx situs in an upper limb were included. For correlation of scintigraphic data versus reduction of volume (RV) surplus measurements, we examined at 4 different time points as follows: preoperatively (T0), within 2 weeks after Tx (T1), 6 to 12 months after Tx (T2), and 32 to 38 months after Tx (T3). An additional long-term follow-up after at least 8 years (T4) was available in some cases.
  
  
  RESULTS
  The maximum individual postoperative observation period was 19 years. In 169 of 177 cases, lymphedema had been caused by treatment of breast cancer (mastectomy, n = 103/169; breast preserving, n = 66/169) and/or radiation therapy (n = 130/177), but 2 patients presented with primary lymphedema. The remaining 6 cases of lymphatic disorders were caused by treatment of malignant melanoma, Hodgkin lymphoma, axillary Ewing sarcoma, non-Hodgkin lymphoma, hemangioma, or abscess removal.At T1, the mean RV of the affected limb was 73%, and the mean improvement of transport index (TI) was 28%. At T2, the RV was 64% and the TI was 23%, and at T3, the RV was 63% and the TI was 25%. Long-term follow-up after at least 8 years (T4: range, 9-19.2; mean, 14.1 years) was available in 19 of 177 patients, in whom persistent improvement in the scintigraphic data (25% decrease in TI) was confirmed by a mean clinical RV of 68%. The mean overall correlation was by a factor of 2.64.
  
  
  CONCLUSIONS
  Our findings in this large set of patients undergoing autologous lymph vessel Tx to an upper limb confirm that this microsurgical technique significantly and persistently improves lymph drainage in patients with lymphedema. The findings of lymphoscintigraphy correlated well with volume measurements at long-term follow-up.
authors.affiliation: From the Departments of *Nuclear Medicine, and †Micro, Hand, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich; and ‡Chirurgische Klinik Munich-Bogenhausen, Munich, Germany.
authors.forename: Mayo
authors.initials: M
authors.lastname: Weiss
authors.forename: Rüdiger G H
authors.initials: RG
authors.lastname: Baumeister
authors.forename: Andreas
authors.initials: A
authors.lastname: Frick
authors.forename: Jens
authors.initials: J
authors.lastname: Wallmichrath
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Axel
authors.initials: A
authors.lastname: Rominger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D042601:Lymphatic Vessels / Q000637:transplantation; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000601:surgery; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous; D034941:Upper Extremity / Q000000981:diagnostic imaging*