Page 37 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire C. Roux
MODERATED POSTER SESSION 2
REPLACEMENT OF OBLITERATED LYMPHATIC COLLECTORS IN OBSTRUCTIVE LYMPHEDEMA BY SILICONE TUBING IMPLANTS
OLSZEWSKI W. L., ZALESKA M.
Central Clinical Hospital, Medical Research Center, Warsaw, Poland
Background: The lymphatic structure of tissue is composed of the intercellular space and lymphatic vessels. The intercellular space is a network of billions of confluent microspaces. Tissue fluid flows from these spaces to the lymphatics. Obliteration of lymphatics, clinically recognized as lymphedema, brings about stasis of fluid with dilatation of the intercellular space. In course of time, large spaces or pseudo-channels are formed. Flow of fluid is hampered by hydraulic resistance of tissue and lack of propelling force. The question arouse whether decongestion of edematous tissue can be accomplished by implantation of artificial channels and application of external compression.
Aim: To study the effect of silicone tubing implants replacing obliterated collecting lymphatics followed by external compression on edema fluid flow to the non-swollen regions.
Material and methods: Study included 25 patients with lymphedema of lower limbs stage III and IV. Twenty patients developed edema after histerectomy and radiotherapy, 5 had infectious skin incidences in the past. Lymphoscintigraphy showed lack of flow of tracer from foot to the groin. Three medical grade hydrophobic silicone tubing o.d.3.2, i.d. 1.8 mm, perforated every 2 cm, were implanted subcutaneously from mid-calf to hypogastrium. Elastic stockings grade II and two weeks of intermittent pneumatic compression were then applied.
Results: After 2 years the mean decrease in circumference in mid-calf was from 1.5 to 5 cm. No expulsion of implant was observed. In 2 cases inflammatory episodes at the hypogastric end of implant, controlled by amoxicillin, were observed. On lymphoscintigraphy tracer was seen in the tubings or around them. On ultrasonography accumulation of fluid around tubings could be shown. In some cases no flow of tracer was observed although there was its evident absorbtion.
Conclusions: Silicone tubing implants in lymphedematous is a low-invasive effective method for decompression of obstructive lymphedema.
CUMULATIVE PATENCY RATE OF LYMPHATIC VENOUS ANASTOMOSIS AND POSTOPERATIVE CHANGES OF COMPRESSION IN TREATMENT OF UPPER LIMB LYMPHEDEMA
MAEGAWA J. 1, MATSUBARA S. 1, MIKAMI T. 1, TOSAKI A. 2
1 Yokohama City University Hospital, Yokohama, Japan
2 Higashikanagawa acupuncture clinic, Yokohama, Japan
Introduction: There are few reports on lymphatic-microsurgery in upper limb lymphedema. We report mid- and long term results in patency of lymphaticovenous side-to-end anastomosis (LVSEA) by real-time lymphangiography and effects to reduce contents of postoperative compression in breast cancer -related lymphedema.
Aim: The aim of this study is to evaluate volume changes of the affected limbs and contents of CDP and patency of the anastomoses.
Methods: Between 2009 and 2012 29 limbs of 29 patients with pre-and postoperative CDP by one institute and LVSEA by one surgeon were evaluated. All of them had breast cancer-related lymphedema. Volumes were calculated based on circumferential measurements at several points of the upper limb pre- and postoperativly. Moving average method was used for comparison of the volume at each period (100days). Patency of 119 anastomoses in the 29 patients was evaluated by real-time ICG fluorescence lymphangiography after surgery with follow-up ranging from 5 to 51 months. We also asked the patients how they put or not compressive garments on the affected limb after surgery.
Results: The mean volume of the affected limb was 1232ml at the initial visit, 1173ml during 1 to 100 days before surgery, and 1146ml during 1 to 100 days after surgery. There were statistical difference between the volumes at initial visit and the mean of a 100- days period before surgery (effect of CDP) and between the mean volumes of a 100-days period before and after surgery (effect of LVSEA). Out of 119 anastomoses 61(51%; 61/119) were detectable. Out of 61 detectable sites 26(43%; 26/61) were patent. Cumulative patency rate decreased gradually over the period of about 4 years. Regarding the compressive garments, 14 patients became freed from putting the garments and contents of CDP were reduced in 11 after surgery.
Discussion: Although volume reduction by our surgical procedures was not much (average 86ml) like in the lower extremity, about a half of the patients became freed from compression garments, which improved QOL of the patents so much. The patency rate of LVSEA in the upper limb lymphedema was similar to that in the lower limb lymphedema in first one year but kept to be relatively high after one year later.
Conclusions: LVSEA is effective to reduce both volume of the affected limb and contents of CDP in the breast cancer related patients.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015