title: Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema.
abstract: Upper limb lymphedema following breast cancer surgery is a challenging problem for the surgeon. Lymphatico-venous or lymphatico-lymphatic anastomoses have been used to restore the continuity of the lymphatic system, offering a degree of improvement. Long-term review indicates that lumen obliteration and occlusion at the anastomosis level commonly occurs with time as a result of elevated venous pressure. Lymph node flap transfer is another microsurgical procedure designed to restore lymphatic system physiology but does not provide a complete volume reduction, particularly in the presence of hypertrophied adipose tissue and fibrosis, common in moderate and advanced lymphedema. Laser-assisted liposuction has been shown to effectively reduce fat and fibrotic tissues. We present preliminary results of our practice using a combination of lymph node flap transfer and laser-assisted liposuction. Between October 2012 and May 2013, ten patients (mean 54.6 ± 9.3 years) with moderate (stage II) upper extremity lymphedema underwent groin or supraclavicular lymph node flap transfer combined with laser-assisted liposuction (high-power diode pulsed laser with 1470-nm wavelength, LASEmaR 1500-EUFOTON, Trieste, Italy). A significant decrease of upper limb circumference measurements at all levels was noted postoperatively. Skin tonicity was improved in all patients. Postoperative lymphoscintigraphy revealed reduced lymph stasis. No patient suffered from donor site morbidity. Our results suggest that combining laser liposuction with lymph node flap transfer is a safe and reliable procedure, achieving a reduction of upper limb volume in treated patients suffering from moderate upper extremity lymphedema.
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, 2 Yuh-Der Road, 40447, Taichung, Taiwan.
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.forename: Joannis
authors.initials: J
authors.lastname: Constantinides
authors.forename: Pedro
authors.initials: P
authors.lastname: Ciudad
authors.forename: Stamatis
authors.initials: S
authors.lastname: Sapountzis
authors.forename: Kidakorn
authors.initials: K
authors.lastname: Kiranantawat
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Seong Yoon
authors.initials: SY
authors.lastname: Lim
authors.forename: Marzia
authors.initials: M
authors.lastname: Nicoli
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Chen
authors.forename: Matthew Sze-Wei
authors.initials: MS
authors.lastname: Yeo
authors.forename: Ram M
authors.initials: RM
authors.lastname: Chilgar
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D001132:Arm / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015187:Lipectomy / Q000379:methods; D008198:Lymph Nodes / Q000601:surgery* / Q000637:transplantation; D008209:Lymphedema / Q000601:surgery*; D008408:Mastectomy; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D016896:Treatment Outcome
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