Publication date: Available online 20 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yukio Seki, Akiyoshi Kajikawa, Takumi Yamamoto, Takayuki Takeuchi, Takahiro Terashima, Norimitsu Kurogi
Abstract
Background
Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
Methods
We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA.
Results
Placement of incisions at a total of 90 forearm sites (3 per patient) yielded creation of 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions." Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018) and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014).
Conclusions
Dynamic LVA is clinically beneficial because the imaging guides decisions over where the incisions should be placed so that a patient's natural hand motions can be utilized to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
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