title: Treatment of postmastectomy lymphedema by bypassing the armpit with implanted silicone tubings.
abstract: BACKGROUND
  Women treated for breast cancer are facing a life-time risk of developing lymphedema in up to 40% of this population. In advanced cases of lymphedema main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces forming fluid "lakes"and "channels". The only solution for fluid drainage would be creating artificial channel for flow away to the non-obstructed regions. The aim of this study was to form artificial pathways for edema fluid flow by subcutaneous implantation of silicone tubes into the swollen limb.
  
  
  METHODS
  Implantation was carried out in ten patients with lymphedema after mastectomy, axillary lymphadenectomy and radiotherapy, stage II and III. Tubes were placed from hand dorsum, through forearm and arm to scapular region. Implantation was followed by routine arm sleeve compression. Prophylactic long term penicillin was administered. The follow-up is at present 10 months.
  
  
  RESULTS
  We observed: implanted tubes brought about fast evacuation of excess tissue fluid; most decrease in circumference, volume and stiffness occurred within first two weeks; less limb heaviness and easier hand grip; lymphoscintigraphy tracer accumulated in tubes and around them; free fluid was seen on ultrasonography at both ends of tubes and in between; no postoperative complications.
  
  
  CONCLUSIONS
  We propose a multimodality method including implantation, limb compression to generate fluid pressure gradient for flow and prevention of inflammation by administration of long-term penicillin. Simplicity of surgical procedure and lack of reaction to implant make the method worth applying in advanced stages of lymphedema in large cohorts of patients.
authors.affiliation: Department of Vascular Surgery, Central Clinical Hospital, Ministry of Home Affairs, Warsaw, Poland - waldemar.l.olszewski@gmail.com; Department of Transplantation Surgery, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Department of Epigenetics, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
authors.forename: Waldemar L
authors.initials: WL
authors.lastname: Olszewski
authors.affiliation: Department of Vascular Surgery, Central Clinical Hospital, Ministry of Home Affairs, Warsaw, Poland; Department of Transplantation Surgery, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Department of Epigenetics, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Department of Applied Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
authors.forename: Marzanna
authors.initials: M
authors.lastname: Zaleska
mesh_terms: D000368:Aged; D001365:Axilla / Q000000981:diagnostic imaging; D000072656:Breast Cancer Lymphedema / Q000209:etiology / Q000628:therapy*; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D011044:Poland; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D019736:Prostheses and Implants; D011878:Radiotherapy / Q000009:adverse effects; D012828:Silicones; D014463:Ultrasonography
chemical_list: D012828:Silicones