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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
UNEXPECTED SUBSTITUTION OF LYMPHATIC PATHWAYS FOLLOWING THE DISSECTION OF THE AXILLARY NODES IN A RAT MODEL:
A POTENTIAL FOR AN INNOVATIVE TREATMENT MODALITY
PASTOURET FRÉDÉRIC. MSC, PT *, CARDOZO LUCIA. MLT *, LAMOTE JAN. MD, PHD **, LIEVENS PIERRE. PHD, PT *
** Vrije Universiteit Brussel, Brussels, Belgium, ** UZ Brussel, Brussels, Belgium.
Address correspondence to:
ABSTRACT
Introduction: Axillary Nodes Dissection (AND) is the major risk factor of Breast Cancer Related Lymphoedema (BCRL). In an animal model Lymphatic Fluid Stasis (LFS) caused by AND appears to be the very first acute phase leading to primary soft tissue changes inducing a secondary lymphoedema.
The main part of physical prevention and treatment of BCRL in humans consists of external mechanical massage of the skin. Manual Lymphatic Drainage (MLD) improves the resorption of LFS and increases lymphatic flow. Other types of external mechanical skin massage as induced by a medical vibration device may induce a similar beneficial effect on the lymphatic system.
Objectives: The objectives of the presented study are double. The first objective is to appreciate the morphological effects of a complete AND on the front leg of a rat (volume) aiming at detecting LFS in the subcutaneous tissues as well as Functional Substitution Lymphatic Pathways (FSLP). The second objective is to analyse the short-term effects on accumulation of dye in the lymph nodes of mice by comparing local massage to multidirectional vibrations delivered in a horizontal position (Andullation).
Methods: Part 1: By applying an innovative posterior surgical approach, a left superficial and deep AND was performed on 30 females Wistar rats who were compared to an untreated group (10 females Wistar rats). Assessing pressure variations of water displacement during legs immersion, volume changes of the two front paws were measured preoperatively and 12 weeks after AND. The volumes were calculated in ml after plethysmometer calibration. To detect LFS and FSLP, Indocyanine Green mapping was performed before and after skin dissection.
Part 2: Ensuing injections of 20 μl Evans blue dye (EBD) in the foot-pads of 2 randomized groups of mice (total N = 15 animals),
Drs PASTOURET Frédéric,
Department of Rehabilitation Research
Faculty of Physical Education and Physiotherapy,
Vrije Universiteit Brussel, Medical Campus, building F, Laarbeeklaan, 103 1090 Brussels, Belgium
Tel: +32 2 477 45 29 - E-mail: Frederic.Pastouret@vub.ac.be
local massage for 5 minutes was applied to one group. The other group underwent 5 minutes whole body vibrations at 30 Hz in a horizontal position (Andullation). Both groups were compared to a non-treated, randomized, but similarly injected control group
(N = 10 mice). Following animal euthanasia, the EBD-stained popliteal and sacral lymph nodes were carefully resected and their contained blue dye extracted. The quantity of EBD (μg) was determined using a spectrophotometric technique with a wavelength of 620 nm.
Results: Part 1: In the control group, FSLP and LFS were never detected and only normal lymphatic pathways were mapped. Volume differences (ml, mean ± sd) were found between the right (2.59 ± 0.29) and left (2.37 ± 0.42) paws but were not statistically significant after 12 weeks (p = 0.2073). At the level of the operated paws in the surgical groups, 43% of rats only presented a regeneration of the interrupted lymphatic pathways, 27% only showed FSLP (perforating lymph vessels), while 30% of the rats presented the two phenomena. None of all the operated and non-operated paws showed evidence of LFS. A statistical difference (p = 0.0350) of front paw volume (ml, mean ± sd) was found between the left operated (2.36 ± 0,31) and the right non-operated paws (2.53 ± 0,26). This indicates that there is no increase of the operated front paw volume compared to the non-operated paw volume.
Part 2: As a result of whole body vibrations in the horizontal position the quantities of EBD in the popliteal lymph nodes were statistically higher than in the control group: respectively 0.56 ± 0.26 and 0.14 ± 0.17 (mean and sd, p<0.05). The quantities of EBD also differed statistically from the recorded quantities following massage: respectively 0.56 ± 0.26 and 0.22 ± 0.16, mean and sd, p<0.05). The quantifications of EBD in sacral lymph nodes revealed strictly identical values.
Conclusions: Contrary to the predetermined hypothesis in the literature and following a period of 12 weeks, AND in a rat does
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
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