title: Lymphatic vessel function and lymphatic growth factor secretion after microvascular lymph node transfer in lymphedema patients.
abstract: BACKGROUND
  Recent reports have shown that microvascular lymph node transfer may improve lymphatic drainage in lymphedema patients. Lymphatic anastomoses are expected to form spontaneously in response to lymphatic growth factor [vascular endothelial growth factor C (VEGF-C)] secreted by the transferred lymph nodes.
  
  
  METHODS
  We have analyzed the results of 19 lymph node transfer patients operated on 2007-2012. Postoperat ive lymphatic function of the affected arm was evaluated using semiquantitative lymphoscintigraphy (transport index) and limb circumference measurements. To investigate the postoperative VEGF-C secretion, we examined axillary seroma fluid samples after different surgical operations, including lymph node transfer.
  
  
  RESULTS
  The transport index was improved postoperatively in 7 of 19 patients. Ten of the 19 patients were able to reduce or even discontinue using compression garments. Arm circumferences were reduced in 12 of 19 patients. Six of the 7 patients with preoperative erysipelas infections have not had infectious episodes postoperatively during 15-67 months follow-up. Neuropathic pain was relieved in 5 of 5 patients. VEGF-C protein was detected in the axillary seroma fluid both after lymph node transfer and normal breast reconstruction.
  
  
  CONCLUSIONS
  Reconstructing the lymphatic anatomy of the axilla with a lymph node flap may offer possibilities that other reconstructive options are lacking. However, we will need further reports and comparative studies about the clinical efficacy of this new promising technique. In addition to the transferred lymph nodes, lymphatic growth factor production may also be induced by other factors related to microvascular breast reconstruction.
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tiina P
authors.initials: TP
authors.lastname: Viitanen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mikko T
authors.initials: MT
authors.lastname: Visuri
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Hartiala
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Maija T
authors.initials: MT
authors.lastname: Mäki
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Marko P
authors.initials: MP
authors.lastname: Seppänen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Erkki A
authors.initials: EA
authors.lastname: Suominen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; and Cleft Unit, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Saaristo