TREATMENT OF POST-MASTECTOMY UPPER LIMB LYMPHEDEMA BY MODIFIED SIDE-TO-END LYMPHATICOVENULAR ANASTOMOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHIPengju ¹ , ZHANGWenlong ¹ ,  ZHAOGang ¹ , LILiang ¹ , CAIHaifeng ²

1. Department of Hand Surgery, the Second Hospital of Tangshan, Hebei Union University, Tangshan Hebei, 063000, P. R. China;
2. Department of Breast Surgery, the People's Hospital, Hebei Union University, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

ZHAOGang, Email: zhaog998@126.com

Keywords：

Lymphaticovenular anastomosis; Breast cancer; Lymphedema

DOI：

10.7507/1002-1892.20150072

Video：

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Objective To investigate the therapeutic effect of modified side-to-end lymphaticovenular anastomosis in the treatment of post-mastectomy upper limb lymphedema. Methods Between May 2010 and May 2011, 11 female patients with post-mastectomy upper limb lymphedema underwent a modified side-to-end lymphaticovenular anastomosis. The average age was 49.5 years (range, 38-55 years). Lymphedema occurred at 7-30 months (mean, 18.3 months) after resection of breast cancer, with an average disease duration of 25.5 months (range, 10-38 months). The left upper limb was involved in 5 cases and the right upper limb in 6 cases. In accordance with difference value between health and affected sides criteria, 5 cases were rated as moderate, and 6 cases as severe. Results Modified side-to-end lymphaticovenular anastomosis was successfully completed in all patients. Primary healing of incision was obtained in the other patients except 1 case of delayed healing. All patients were followed up for an average of 38.4 months (range, 36-40 months). Limb pain and swelling were relieved; no episodic attack or recurrence was observed. The circumference of affected upper arm was significantly decreased from preoperative (33.9±3.7) cm to postoperative (31.0±3.5) cm at 6 months and (30.9±3.5) cm at 36 months (P<0.05), but no significant difference was found between at 3 and 6 months (P>0.05); the circumference of affected forearm was significantly decreased from preoperative (30.1±3.6) cm to postoperative (27.8±3.4) cm at 6 months and (27.7±3.3) cm at 36 months (P<0.05), but no significant difference was shown between at 6 and 36 months (P>0.05). According to Campisi evaluation standard to assess efficacy, the results were excellent in 3 cases, good in 6 cases, and improved in 2 cases. Conclusion Using modified side-to-end lymphaticovenular anastomosis may be effective in the treatment of upper limb lymphedema after mastectomy.

Citation： SHIPengju, ZHANGWenlong, ZHAOGang, LILiang, CAIHaifeng. TREATMENT OF POST-MASTECTOMY UPPER LIMB LYMPHEDEMA BY MODIFIED SIDE-TO-END LYMPHATICOVENULAR ANASTOMOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 339-342. doi: 10.7507/1002-1892.20150072 Copy

1.	Pusic AL, Cemal Y, Albomoz C, et al. Quality of life among breast cancer patients with lymphedema:a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv, 2013, 7(1):83-92.
2.	Yamamoto T, Narushima M, Kikuchi K, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg, 2011, 127(5):1987-1992.
3.	苏韦祯, 穆籣. 乳腺癌术后上肢淋巴水肿的治疗现状. 中国美容医学, 2008, 17(6):935-937.
4.	Fu MR, Ridner SH, Armer J. Post-breast cancer. Lymphedema:part 1. Am J Nurs, 2009, 109(2):48-54.
5.	Campisi C, Bellini C, Campisi C, et al. Microsurgery for lymphedema:clinical research and long-term results. Microsurgery, 2010, 30(4):256-260.
6.	Auba C, Marre D, Rodriguez-Losada, et al. Lymphaticovenular anastomoses for lymphedema treatment:18 months postoperative outcomes. Microsurgery, 2012, 32(4):261-268.
7.	Felmerer G, Sattler T, Lohrmann C, et al. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery, 2012, 32(3):171-177.
8.	Yamamoto T, Iida T, Matsuda N, et al. Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphedema. J Plast Reconstr Aesthet Surg, 2011, 64(11):1541-1544.
9.	Mihara M, Hara H, Narushima M, et al. Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization:A case report. Microsurgery, 2012, 32(3):227-230.
10.	Maegawa J, Yabuki Y, Tomoeda H, et al. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg, 2012, 55(3):753-760.
11.	Clodius L, Piller NB, Casley-Smith JR. The problem of lymphatic microsurgery for lymphedema. Lymphology, 1981,14(2):69-76.
12.	Campisi C. Lymphatic microsurgery:a potent weapon in the war on lymphedema. Lymphology, 1995, 28(3):110-112.
13.	Campisi C, Da Rin E, Bellini C, et al. Pediatric lymphedema and correlated syndromes:role of microsurgery. Microsurgery, 2008, 28(2):138-142.
14.	Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment:derivative lymphatic venous microsurgery. World J Surg, 2004, 28(6):609-613.
15.	汪忠镐. 汪忠镐血管外科学. 杭州:浙江科学技术出版社, 2010:1290-1331.

1. Pusic AL, Cemal Y, Albomoz C, et al. Quality of life among breast cancer patients with lymphedema:a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv, 2013, 7(1):83-92.
2. Yamamoto T, Narushima M, Kikuchi K, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg, 2011, 127(5):1987-1992.
3. 苏韦祯, 穆籣. 乳腺癌术后上肢淋巴水肿的治疗现状. 中国美容医学, 2008, 17(6):935-937.
4. Fu MR, Ridner SH, Armer J. Post-breast cancer. Lymphedema:part 1. Am J Nurs, 2009, 109(2):48-54.
5. Campisi C, Bellini C, Campisi C, et al. Microsurgery for lymphedema:clinical research and long-term results. Microsurgery, 2010, 30(4):256-260.
6. Auba C, Marre D, Rodriguez-Losada, et al. Lymphaticovenular anastomoses for lymphedema treatment:18 months postoperative outcomes. Microsurgery, 2012, 32(4):261-268.
7. Felmerer G, Sattler T, Lohrmann C, et al. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery, 2012, 32(3):171-177.
8. Yamamoto T, Iida T, Matsuda N, et al. Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphedema. J Plast Reconstr Aesthet Surg, 2011, 64(11):1541-1544.
9. Mihara M, Hara H, Narushima M, et al. Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization:A case report. Microsurgery, 2012, 32(3):227-230.
10. Maegawa J, Yabuki Y, Tomoeda H, et al. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg, 2012, 55(3):753-760.
11. Clodius L, Piller NB, Casley-Smith JR. The problem of lymphatic microsurgery for lymphedema. Lymphology, 1981,14(2):69-76.
12. Campisi C. Lymphatic microsurgery:a potent weapon in the war on lymphedema. Lymphology, 1995, 28(3):110-112.
13. Campisi C, Da Rin E, Bellini C, et al. Pediatric lymphedema and correlated syndromes:role of microsurgery. Microsurgery, 2008, 28(2):138-142.
14. Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment:derivative lymphatic venous microsurgery. World J Surg, 2004, 28(6):609-613.
15. 汪忠镐. 汪忠镐血管外科学. 杭州:浙江科学技术出版社, 2010:1290-1331.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF POST-MASTECTOMY UPPER LIMB LYMPHEDEMA BY MODIFIED SIDE-TO-END LYMPHATICOVENULAR ANASTOMOSIS

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