Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (<25 cm2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR.

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

An innovative wireless device for bioimpedance analysis was developed for post-dual-site free vascularized lymph node transfer (VLNT) evaluation. Seven patients received dual-site free VLNT for unilateral upper or lower limb lymphedema. A total of 10 healthy college students were enrolled in the healthy control group. The device was applied to the affected and unaffected limbs to assess segmental alterations in bioimpedance. The affected proximal limb showed a significant increase in bioimpedance at postoperative sixth month (3.3 [2.8, 3.6], p = 0.001) with 10 kHz currents for better penetration, although the difference was not significant (3.3 [3.3, 3.8]) at 1 kHz. The bioimpedance of the affected distal limb significantly increased after dual-site free VLNT surgery, whether passing with the 1 kHz (1.6 [0.7, 3.4], p = 0.030, postoperative first month; 2.8 [1.0, 4.2], p = 0.027, postoperative third month; and 1.3 [1.3, 3.4], p = 0.009, postoperative sixth month) or 10 kHz current ((1.4 [0.5, 2.7], p = 0.049, postoperative first month; 3.2 [0.9, 6.3], p = 0.003, postoperative third month; and 3.6 [2.5, 4.1], p < 0.001, postoperative sixth month). Bioimpedance alterations on the affected distal limb were significantly correlated with follow-up time (rho = 0.456, p = 0.029 detected at 10 kHz). This bioimpedance wireless device could quantitatively monitor the interstitial fluid alterations, which is suitable for postoperative real-time surveillance.

Limb volume reduction and infection outcomes following vascularized lymph node transfer for cancer treatment-related lymphoedema: A systematic review and meta-analysis.

e24040 Background: Cancer treatment-related lymphoedema (CTRL) is a chronic and disabling complication that carries a significant health burden during cancer survivorship. Vascularized lymph node transfer (VLNT) is employed increasingly to microsurgically reconstruct physiological lymphatic flow in affected limbs. We set out to synthesise and assess the efficacy of VLNT for reducing limb volume and infection outcomes in CTRL. Methods: A systematic review was conducted by searching PubMed, Medline and EMBASE databases during early 2020. All full-text English-language articles reporting VLNT as the sole therapeutic intervention for the management of CTRL that provided volumetric limb and/or patient-reported lymphatic quality of life and/or cellulitis-related outcomes were included. All studies were scored for methodological quality (STROBE and CONSORT checklists) and lymphoedema-specific data reporting quality. Using a random-effects model, we estimated the pooled limb volume reduction and 95% CI for upper and lower limbs stratifying according to site of measurement and VLNT donor. We also estimated the pooled reduction in cellulitis episodes and mean improvement in lymphoedema-related quality of life. PROSPERO ID: CRD42020204080. Results: The search strategy identified 277 articles. Thirty-one studies encompassing 581 patients were included with the overall methodological quality of studies assessed to be low. Meta-analysis demonstrated that performing VLNT for CTRL led to limb volume reductions in both upper limb (above elbow circumferential reduction rates (CRR) = 42.7 % (95% CI: 36.5-48.8, I2: 94.3 %, p = 0.000, 153 patients, 10 studies); below elbow CRR = 34.1 % (95% CI: 33.0-35.1, I2: 0.0 %, p = 0.919, 144 patients, 9 studies)) and lower limb (above knee CRR = 46.8 % (95% CI: 43.2-50.4, I2: 92.4 %, p = 0.000 26 patients, 3 studies); below knee CRR = 54.6 % (95% CI: 39.0-70.2, I2: 97.6%, p = 0.000, 26 patients, 3 studies)) CTRL. Similarly, extra-abdominal VLNT, abdominal VLNT and autologous breast reconstruction with VLNT reduced CTRL by CRRs of 49.5 % (95% CI: 46.5-52.5, I2: 8.3 %, p = 0.365, 7 studies, 108 patients), 39.6 % (95% CI: 37.2-42.0, I2: 89.5 %, p = 0.000, 3 studies, 15 patients) and 32.7 % (95% CI: 11.1-54.4, I2: 96.9 %, p = 0.000 3 studies, 29 patients). VLNT reduced mean annual cellulitis episodes by 2.1 (95% CI: -2.7- -1.4) episodes per annum and improved lymphoedema-specific quality of life was improved by 4.26 (LYMQOL “overall domain” scale). Conclusions: Performing VLNT for CTRL results in reductions of limb volume and cellulitis episodes for both upper and lower limbs. However, published studies were methodologically heterogeneous and of low quality highlighting the need for standardized outcome reporting and further well-designed randomized controlled trials comparing VLNT against existing therapies.

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).Conclusion: The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.