title: Surgical treatment of secondary lymphedema of the upper limb by stepped microsurgical lymphaticovenous anastomoses.
abstract: The incidence of lymphedema following treatment for breast cancer ranges between 10 and 50% after complete axillary dissection and gives rise to severe functional discomfort in patients. Results of lymphaticovenous anastomoses (LVA) in surgical treatment of lymphedema appear to be favorable. However, the available literature on this topic is scarce, often with short follow-up times. The aim of this study is to analyze the results of LVA on 31 patients and to review the existing literature.
  
  
  
  This study comprised 31 female patients presenting lymphedema of the upper limb following treatment for breast cancer for which surgical treatment was given by microsurgery consisting of three stepped LVA performed in an outpatient setting.
  
  
  
  The post-LVA arm circumference was measured at three levels (wrist, forearm, and arm) in 31 female patients. Mean follow-up time was 12.8 months. Reduction in the circumference was 22.5, 21.32, and 30.2%, respectively, in the wrist, forearm, and arm. Functional improvement was observed in the majority (84%) of patients ranging from moderate to substantial. Only 2 patients had no result. The only patients to experience recurrence were those with a high level of lymphedema.
  
  
  
  The review of the current literature and the present study revealed modest results in terms of decreased excess volume, although a major improvement in function points to LVA as a useful technique in this indication. Progress in imaging techniques has enhanced the results achieved with this procedure, although further studies on recurrence rates are needed with a follow-up greater than 1 year.
authors.affiliation: Service de Chirurgie Plastique et Réparatrice, Centre hospitalo-universitaire de Pasteur, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France. ma.poumellec@gmail.com.|Service de Chirurgie Plastique et Réparatrice, Hôpital Pasteur 2, CHU Nice, 30 voie Romaine, 06100, Nice, France. ma.poumellec@gmail.com.
authors.forename: Marie-Anne
authors.identifier: 0000-0002-7000-3421
authors.initials: MA
authors.lastname: Poumellec
authors.affiliation: Service de Chirurgie Plastique et Réparatrice, Centre hospitalo-universitaire de Pasteur, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Foissac
authors.affiliation: Service de Chirurgie Plastique et Réparatrice, Centre hospitalo-universitaire de Pasteur, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Cegarra-Escolano
authors.affiliation: Service de chirurgie sénologique et gynécologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, Cedex 2, 06189, Nice, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.affiliation: Service de chirurgie sénologique et gynécologique, Centre Antoine Lacassagne, 33 avenue de Valombrose, Cedex 2, 06189, Nice, France.
authors.forename: Tarik
authors.initials: T
authors.lastname: Ihrai
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001943:Breast Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D016896:Treatment Outcome
keywords: Axillary node; Breast cancer; Lymphedema; Lymphovenous anastomosis