What is the impact of lymphnode dissection in the context of lymphedema?3 answersAxillary lymph node dissection (ALND) in the context of lymphedema has been studied in several papers. One study found that neoadjuvant chemotherapy (NAC) was an independent risk factor for breast cancer-related lymphedema (BCRL) in patients who underwent ALND. Animal models have provided insights into the pathogenesis of lymphedema and have explored potential treatments such as growth factor-mediated therapies and nanofibrillar collagen scaffold. Another study investigated the use of compression sleeves in preventing arm swelling after ALND and found that the use of compression sleeves reduced the incidence of arm swelling. Additionally, a study on the LYMPHA technique, which involves lymphatic microsurgical preventive healing approach during nodal dissection, showed promising results in reducing the incidence of lymphedema after ALND. These studies highlight the impact of ALND on lymphedema and provide insights into potential preventive measures and treatment options.
How do lymphatic microsurgical techniques work?3 answersLymphatic microsurgical techniques, such as lymphovenous bypass (LVB) and lymphaticovenous anastomosis (LVA), work by creating connections between lymphatic vessels and veins to improve lymphatic drainage. LVB involves anastomosing lymphatic ducts less than 0.8 mm in diameter to subdermal venules, while LVA directly connects lymphatic vessels to superficial veins. These techniques require high-resolution magnification microscopes, super-fine microsurgical instruments, and sutures for successful performance. Lymphatic microsurgery is effective in treating peripheral lymphedema, especially in the early stages, by restoring lymphatic drainage and reducing volume. Patient selection, surgical planning, technique standardization, and postoperative care are important factors in achieving favorable outcomes with these techniques. Preoperative evaluation using indocyanine green lymphography and immediate postoperative compression are recommended for optimal results.
What is lymphovenous bypass?3 answersLymphovenous bypass is a microsurgical technique performed after lymph node dissection to prevent lymphedema. It involves connecting a severed lymphatic channel to a low-pressure venule, allowing lymphatic fluid to bypass the blocked or damaged lymphatic vessels and flow directly into the venous system. The location of the bypass anastomoses and their feasibility of shielding from radiotherapy (RT) dose have been studied in the context of breast cancer-related lymphedema (BCRL). Lymphovenous bypass has shown promising results in the treatment of symptomatic thoracic duct (TD) occlusion, improving conditions such as chylous ascites, protein-losing enteropathy, lymphedema, and chylothorax/plastic bronchitis. The technique has also been used for recalcitrant mechanical TD obstruction, with short-term tolerability and potential physiological changes that require further investigation. Prophylactic lymphovenous bypass using a branched vein graft has been effective in reducing the risk of lymphedema after axillary lymph node dissection.
Is CT useful for diagnosing lymphedema?5 answersCT is useful for diagnosing lymphedema. Lymphoscintigraphy with SPECT/CT provides more information about the function and morphology of the lymphatic system compared to scintigraphy alone. It allows for precise location of foci and is preferred over other tracers like phytate for clearer images and better identification of linear patterns. Additionally, CT can be used to evaluate the clinical significance of left iliac vein obstruction (IVO) in patients with lower extremity lymphedema, although it should be reserved for cases with isolated left-sided or bilateral edema and clinical suspicion for May-Thurner Syndrome (MTS). CT is also used to assess the findings before and after lymphovenous anastomosis (LVA) surgeries and correlate them with volume changes in the limbs. Overall, CT plays a valuable role in the diagnosis and evaluation of lymphedema.
Abdominoplasty reverse lymphatic drainage?5 answersAbdominoplasty can result in a significant change in the pattern of lymphatic drainage in the infraumbilical region. Before surgery, the lymphatic drainage pathway in the abdominal wall is towards the inguinal lymph nodes. However, after abdominoplasty, the predominant drainage pathway shifts towards the axillary lymph node chain, with some cases exhibiting alternative drainage pathways. This change in lymphatic drainage can increase the risk of complications such as seroma formation. Manual lymphatic drainage techniques may need to be modified based on these alterations. No significant changes in lymphatic drainage were observed between 1 and 6 months postoperatively. The use of surgical drains in abdominoplasty procedures to prevent complications like seroma formation is still a topic of debate. Some studies suggest that drains may not be necessary and that complications rates are not significantly different between patients with and without drains.
What is lymphedema?4 answersLymphedema is a chronic and debilitating disease characterized by the accumulation of excess fluid in the body due to impaired lymphatic drainage. It can be either primary, caused by genetic abnormalities, or secondary, resulting from damage to the lymphatic system due to cancer treatment or other factors. Secondary lymphedema is the most common form and often affects patients with breast cancer after lymph node dissection. The disease is progressive and can lead to chronic swelling, fibroadipose deposition, and impaired function. Recent research suggests that lymphatic injury triggers a chronic inflammatory response involving T-cell inflammation. Treatment aims to reduce swelling, restore function, and prevent complications. Surgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer have shown promise in restoring lymphatic flow.