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Nicolás Pereira, Álvaro Cámbara, Matías Kufeke, Ricardo Roa
Post-traumatic lymphedema is poorly understood. It is rarely considered in limb reconstruction decision-making approach. We report a case of a 41-year-old female who presented with right upper extremity lymphedema after degloving injury and split thickness skin graft, successfully treated with a superficial circumflex iliac artery perforator (SCIP) free flap restoring the lymphatic drainage. Right upper extremity had an excess of 258.7 mL or an excess volume of 27.86% compared to the healthy contralateral limb...
February 15, 2019: Microsurgery
Guido Giacalone, Takumi Yamamoto, Akitatsu Hayashi, Florence Belva, Mieke Gysen, Nobuko Hayashi, Nana Yamamoto, Isao Koshima
BACKGROUND: Lymphocele and lymphorrhea are frequent complications after lymph node excision. Recurrent lymphoceles and intractable lymphorrhea are particularly difficult to treat conservatively. We describe the outcomes of four patients with recurrent lymphocele and nine patients with persistent lymphorrhea that were treated by supermicrosurgery. METHODS: Four patients with recurrent lymphoceles with a size between 7 and 21 cm and located in the groin (n = 1) or upper leg (n = 3), were referred for surgical treatment between 2013 and 2017 after unsuccessful conservative therapy...
February 14, 2019: Microsurgery
Ciro Esposito, Francesco Turrà, Fulvia Del Conte, Serena Izzo, Francesca Gargiulo, Alessandra Farina, Giovanni Severino, Mariapina Cerulo, Maria Escolino
BACKGROUND: Laparoscopic Palomo varicocelectomy is one the most common approaches adopted to treat pediatric varicocele, but postoperative hydrocele still remains a potential problem with this procedure. This study aimed to evaluate the outcome of a new technique of lymphography using indocyanine green (ICG)-enhanced fluorescence to perform lymphatic sparing laparoscopic Palomo varicocelectomy. PATIENTS AND METHODS: The records of 25 patients who underwent laparoscopic left varicocelectomy in our unit from March 2017 to March 2018 were retrospectively evaluated...
January 24, 2019: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Shinsuke Akita, Yoshihisa Yamaji, Motone Kuriyama, Hideki Tokumoto, Tatsuya Ishigaki, Takafumi Tezuka, Hideyuki Ogata, Yoshitaka Kubota, Nobuyuki Mitsukawa
BACKGROUND:  Although the usefulness of efferent lymphaticovenular anastomosis (ELVA) in lymphatic microsurgery has been reported, the optimal method to distinguish efferent from afferent lymphatics is not yet established. We propose a novel technique to detect efferent lymphatics appropriate for anastomosis. METHODS:  In total, 62 groin lymph nodes (LNs) of 46 limbs were divided into four groups based on the findings of indocyanine green lymphography: n  = 15 in normal, 15 in dermal backflow stage 0, 18 in stage I, and 14 in stage II groups...
January 21, 2019: Journal of Reconstructive Microsurgery
Yushi Suzuki, Hisashi Sakuma, Shun Yamazaki
OBJECTIVE: Lymphaticovenous anastomosis (LVA) is one of the surgical treatments of lymphedema. However, only a few reports have evaluated LVA directly. This study aimed to evaluate the patency of LVA using indocyanine green fluorescence lymphography and to determine the optimal anastomosis site in patients with lower extremity lymphedema. METHODS: Thirty-six patients, with a total of 123 anastomoses for lower extremity lymphedema including 3 cases of idiopathic lymphedema, who underwent LVA for the first time between March 2014 and March 2017 were selected for enrollment in this study...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Ming-Huei Cheng, Charles Yuen Yung Loh, Chia-Yu Lin
Background: Primary lymphedema is a debilitating disease. This study was to investigate the outcomes between vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) for treating primary lymphedema. Methods: Between January 2010 and December 2016, 17 patients with mean age of 31.5 ± 15.5 (ranged, 2-57) years diagnosed with 19 primary limb lymphedema were recruited. Patients with patent lymphatic ducts on indocyanine green lymphography were indicated for LVA, whereas those without patent lymphatic ducts were indicated for VLNT...
December 2018: Plastic and Reconstructive Surgery. Global Open
Harm Winters, Hanneke J P Tielemans, Arico C Verhulst, Vera A A Paulus, Nicholas J Slater, Dietmar J O Ulrich
BACKGROUND AND OBJECTIVES: Lymphedema is a condition that can greatly affect patient's quality of life. Promising results have been described with lymphaticovenular anastomosis (LVA) in the treatment of lymphedema. It is currently unknown at what rate anastomoses remain functional after a longer follow-up. The aim of this study was to determine LVA patency at 1-year follow-up. METHODS: Retrospective chart review was performed on patients who underwent LVA surgery...
February 2019: Annals of Plastic Surgery
Katharina Zetzmann, Ingo Ludolph, Raymund E Horch, Anja Miriam Boos
Lipoedema is a progressive disease, which predominantly affects women. It is characterised by circumferential growth, with increase in fat tissue of the extremities, and can lead to oedema. In contrast, the lymphoedema is defined by a specific lymphatic drainage disorder and can lead to fibrosis of the surrounding connective tissue. While lipoedema is diagnosed through clinical symptoms and diagnostic imaging can usually only be used to rule out comorbidities, lymphatic drainage disorder can be visualised using imaging methods...
December 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
Yusuke Taki, Shinsuke Sato, Katsunori Suzuki, Erina Nagai, Masaya Watanabe, Yuichiro Shishido, Nobuaki Nakajima, Masakazu Takagi
BACKGROUND: Lymphography with Lipiodol is useful for chylothorax. There were many slight complications, but reports of acute respiratory distress syndrome (ARDS) after lymphography were few. CASE PRESENTATION: A 75-year-old man with esophageal cancer developed chylothorax after esophagectomy. Conservative treatment was ineffective, and he underwent lymphography with 8.5 mL of Lipiodol. He developed a high fever soon after lymphography, followed by severe ARDS requiring artificial respiration 5 days later...
January 3, 2019: Surgical Case Reports
Marco Mazza, Antonio Sommariva
INTRODUCTION: Lymphocele occurs frequently after regional lymph node dissection. Surgery with multiple lymphatic ligation represents the only reliable treatment for long-standing chronic lymphocele. MATERIALS AND SURGICAL TECHNIQUE: We report the case of a man with chronic axillary seroma after axillary lymphadenectomy for melanoma. The lymphocele was unresponsive to conservative management and successfully treated with indocyanine green lymphography-guided video-assisted axillary surgery...
December 13, 2018: Asian Journal of Endoscopic Surgery
Hisako Hara, Makoto Mihara
BACKGROUND: Detecting more number of functional lymphatic vessels is the essential point in lymphaticovenous anastomosis (LVA). The purpose of this prospective study was to elucidate the efficacy of multi-area injection in indocyanine green (ICG) lymphography in LVA. METHODS: We injected ICG into the first web spaces of the feet or the second web space of the hands, subcutaneously. In multi-area injection group, we injected additional ICG in other areas. We determined the incision design of LVA on the line at about 5 cm distal to dermal backflow point...
December 3, 2018: Microsurgery
Kosuke Ishikawa, Taku Maeda, Emi Funayama, Toshihiko Hayashi, Naoki Murao, Masayuki Osawa, Hiroshi Furukawa, Akihiko Oyama, Yuhei Yamamoto
PURPOSE: Vascularized lymph node transfer is becoming more common in the treatment of lymphedema, but suitable small animal models for research are lacking. Here, we evaluated the feasibility of pedicled vascularized inguinal lymph node transfer in mice. METHODS: Twenty-five mice were used in the study. An inguinal lymph node-bearing flap with a vascular pedicle containing the superficial caudal epigastric vessels was transferred into the ipsilateral popliteal fossa after excision of the popliteal lymph node...
December 3, 2018: Microsurgery
Hiroshi Ashiba, Ryohei Nakayama
Sentinel lymph node (SLN) biopsy for evaluating lymph node metastasis during breast cancer surgery is associated with several problems, such as the consequent increase in operation time and the possibility of abrupt changes in the treatment plan during the operation. Although it is desirable to distinguish SLNs with and without cancer metastasis before surgery, there is no established examination for this purpose. This study aimed to develop a computerized scheme for evaluating metastasis in SLNs by analyzing computed tomography lymphography images and the three-dimensional versions of these images...
November 29, 2018: Radiological Physics and Technology
Amit Goyal
The 'standard of care' method for sentinel node mapping is the combination technique using radioisotope and blue dye although some centres use radioisotope or blue dye alone. Radioisotope usage requires licensing, has regulatory issues around handling and disposal of waste, and logistically may be unavailable or difficult to implement in some centres or less developed country. This has led to the development of alternative methods such as superparamagnetic iron oxide (SPIO), fluorescence techniques using indocyanine green (ICG) or fluorescein, computed tomography lymphography, and contrast-enhanced ultrasound scan (CEUS) using microbubbles...
October 2018: Breast Care
Corinne Becker, Lionel Arrivé, Giuseppe Mangiameli, Ciprian Pricopi, Fanomezantsoa Randrianambinina, Francoise Le Pimpec-Barthes
Post-traumatic localized hand lymphedema is a rare situation and its diagnosis may be difficult, causing lack of care leading to failure of care. Our case study is of two young women with massive post-traumatic hand lymphedema who were treated for algodystrophy for 2 years, and whose bandages and physiotherapy were unsuccessful. Major social and psychological consequences due to difficulty with diagnosis and management resulting in inappropriate tests and therapeutic treatment were prescribed due to these issues...
2018: SICOT-J
Hiroo Suami, Louise Koelmeyer, Helen Mackie, John Boyages
Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe...
December 2018: Surgical Oncology
Yushi Suzuki, Hisashi Sakuma, Shun Yamazaki
OBJECTIVE: Lymphaticovenous anastomosis (LVA) is one of the surgical treatments for lymphedema. Lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis (LVEEA) are the most commonly used procedures; however, only a few reports have evaluated direct anastomosis. We used indocyanine green fluorescence lymphography to evaluate and to compare both techniques. METHODS: Eighteen patients (67 anastomoses) with secondary upper extremity lymphedema were evaluated 6 months postoperatively...
November 12, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
In Gyu Kwon, Taeil Son, Hyoung-Il Kim, Woo Jin Hyung
Importance: Fluorescent imaging with indocyanine green can be used to visualize lymphatics. Peritumoral injection of indocyanine green may allow for visualization of every draining lymph node from a primary lesion on near-infrared imaging. Objectives: To evaluate the role of fluorescent lymphography using near-infrared imaging as an intraoperative tool for achieving complete lymph node dissection and compare the number of lymph nodes retrieved with the use of near-infrared imaging and the number of lymph nodes retrieved without the use of near-infrared imaging...
November 14, 2018: JAMA Surgery
Marco G Patti, Francisco Schlottmann, Marco Di Corpo
No abstract text is available yet for this article.
November 14, 2018: JAMA Surgery
Christopher J Coroneos, Franklin C Wong, Sarah M DeSnyder, Simona F Shaitelman, Mark V Schaverien
BACKGROUND: Bioimpedance spectroscopy (BIS) is an established tool for the measurement of extracellular fluid in lymphedema. This study assesses the validity of BIS measurements using the l-Dex® for evaluating the effectiveness of interventions to treat lymphedema. Measurements are correlated with limb volume, assessment of pitting edema, physiologic measures of lymphatic function, and response to surgical intervention. Three l-Dex BIS metrics are compared. METHODS AND RESULTS: This retrospective study of prospectively collected data identified consecutive patients with lymphedema...
November 2, 2018: Lymphatic Research and Biology
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