title: Lymph node grafting in the treatment of upper limb lymphoedema: a clinical trial.
abstract: BACKGROUND
  Microvascular lymph node transfer has been shown to improve the severity of lymphoedema. However, microvascular surgery is not suitable for all patients. Simple lymph node grafting does not require general anaesthetic or significant surgical resources and is a technique that has been tested in animal models only until this point. Our hypothesis is that the transplanted lymph nodes integrate into the lymphovascular system and function as a 'pump', directly pumping interstitial fluid back into the venous system.
  
  
  METHODS
  We hypothesized that lymph node grafting would improve lymphoedema with a low risk of complications. The procedure was performed in a day surgery setting under local anaesthetic with sedation. Two lymph nodes were harvested from the groin and grafted into subcutaneous tissue on the volar aspect of the affected limb at supratrochlear and wrist levels.
  
  
  RESULTS
  We found that nine of 10 patients reported a subjective and/or functional improvement in their lymphoedema, including an improvement in hand function and tissue feel. Truncal cone calculation volumes showed an overall decrease in affected limb volume of 89.7 mL (standard deviation = 136.5). Furthermore, follow-up lymphoscintigram imaging on one patient demonstrated viability and function of the implanted node.
  
  
  CONCLUSIONS
  We conclude that this is a safe procedure and should be further investigated as an alternative to a microsurgical procedure as a treatment for upper limb lymphoedema. Further research with a larger sample size is needed to confirm the findings of this pilot study.
authors.affiliation: Plastic and Reconstructive Surgery Department, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Travis
authors.affiliation: Plastic and Reconstructive Surgery Department, Hutt Hospital, Wellington, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Shugg
authors.affiliation: Plastic and Reconstructive Surgery Department, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Winston M
authors.initials: WM
authors.lastname: McEwan
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000637:transplantation*; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D016378:Tissue Transplantation / Q000379:methods*; D034941:Upper Extremity / Q000098:blood supply*
keywords: axillary dissection; breast cancer; lymph node; lymph node grafting; lymphoedema