Page 21 - VOL 26 N. 72 - 2015

LIPOSUCTION OF POSTMASTECTOMY ARM LYMPHEDEMA DECREASES THE INCIDENCE OF ERYSIPELAS
BRORSON H. 2, LEE D. 1, PILLER N. 1, HOFFNER M. 2
1 Lymphoedema Research Unit, Department of Surgery, School of Medicine, Flinders University, Adelaide (AU); 2 Lymphedema Center, Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö (SE)
Introduction: The objective of this study was to assess erysipelas incidence before and after liposuction, a treatment for patients suffering from post-mastectomy lymphedema.
Methods and Results: A prospective cohort study of 130 patients at Skåne University Hospital in Malmö, Sweden with postmastectomy arm lymphedema, who had poor outcomes from prior conservative treatment and clinical signs of subcutaneous adipose tissue hypertrophy underwent liposuction between 1993-2012. Pre- and postoperative bouts of erysipelas were available for all of them. Mean duration of lymphedema prior to liposuction was 8.8 years (range1-38, standard deviation (SD) 7.0 years). Mean age at liposuction was 63 years (range 39-89, SD 10 years). Total pre liposuction observation years were 1147, and total post-liposuction observation years were 983. Erysipelas incidence dropped from 0.47 attacks/year (range 0-5.0, SD 0.8 attacks/year) to 0.06 attacks/year (range 0-3.0, SD 0.3 attacks/year) after liposuction, a reduction of 87%. Also, compared to 76 patients who experienced at least 1 erysipelas episode preoperatively, only 19 patients experienced erysipelas postoperatively. Of the 54 patients who did not have erysipelas preoperatively, 6 patients had erysipelas postoperatively. The total number of erysipelas attacks observed decreased from 534 to 60 bouts after liposuction.
Conclusion: Liposuction significantly reduced the incidence of erysipelas in patients with post mastectomy arm lymphedema who prior to the intervention suffered one or more attacks.
LYMPHATIC COMPLICATIONS CONTROL FOLLOWING INGUINAL AND AXILLARY RADICAL LYMPH NODE DISSECTION: A RANDOMIZED CONTROLLED TRIAL
MATTHEY-GIÉ M.-L., GIÉ O., DERETTI S., DEMARTINES N., MATTER M.
CHUV, Lausanne, Switzerland
Background: Many attempts to prevent lymphatic complications following radical lymph node dissection (RLND) have included modifications in surgical techniques by the use of ultrasonic scalpels or injection of lymphostatic agent. Previous randomized studies, enrolling heterogeneous groups of patients, tried to confirm the efficacy of such techniques. The aim of this present study was to evaluate the efficacy of the Harmonic scalpel for RLND.
Methods: Between 2009 and 2013 in a tertiary academic centre, patients undergoing inguinal or axillary RLND or completion lymph node dissection after positive sentinel lymph node biopsy (SLNB) for melanoma or sarcoma, were randomized in a controlled trial comparing two surgical dissection techniques. In group HS dissection was conducted with Harmonic Scalpel and in group control (C) by ligation and monopolar electrocautery. For axillary dissection a standardized level III lymphadenectomy was routinely performed. A complete inguinal lymphadenectomy including Cloquet’s node was performed in the groin. At the end of the procedure, one closed Redon suction drain was systematically placed in the armpit and in the groin respectively. Our primary endpoint was to compare the time until drain removal in both groups. The secondary endpoint was to evaluate the rate of complications (infection, fistula, lymphocele formation, wound dehiscence, lymphedema) in both groups.
Results: 80 patients were enrolled in this trial. 40 patients were randomly assigned in group HS and C respectively. No significant difference was observed in term of duration of drainage (H: 30.91±19.6 vs. C: 31.9 ±17.56, p=0.83). A significant increased rate of lymphoedema (defined as an increased circumference of the operated limb of more than 10%) was identified in group H (H: 50% vs. C: 20.5%, p=0.04). No other difference was recorded for postoperative complication as surgical site infection (H: 5% vs. C: 7.5%; p=0.68); lymphatic fistula (H: 5% vs. C: 2.5%; p=0.62); lymphocoele (H: 32.5% vs. C: 22.5%; p=0.33) and hematoma (H: 5% vs. C: 2.5%; p=0.62).
Conclusion: The use of harmonic scalpel failed to offer a significant reduction for length of drainage and operative complication, even an increased rate of lymphoedema was observed.
Thus, “traditional” surgical management can be used safely in RLND.
18
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015