Yamamoto Takumi, Yoshimatsu Hidehiko, Yamamoto Nana
Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2016 Sep;69(9):1227-33. doi: 10.1016/j.bjps.2016.06.028. Epub 2016 Jul 2.
Treatment of primary lower extremity lymphedema (LEL) is challenging, and lymph node transfer (LNT) can be a choice of treatment for progressive LEL. However, LNT has a risk of donor site lymphedema and possible lymph node (LN) sclerosis due to efferent lymphatic vessel (ELV) obstruction. Here, we report the first case of complete lymph flow reconstruction with true perforator LNT with efferent lymphaticolymphatic anastomosis (ELLA) for a patient with primary LEL and severe lymphosclerosis. A 49-year-old female suffered from primary progressive unilateral left LEL refractory to conservative treatments with frequent episodes of cellulitis. A true perforator LN flap was selectively harvested from the left lateral thoracic region under indocyanine green (ICG) lymphography navigation and transferred to the left groin with perforator-to-perforator anastomosis. The ELV of the transplanted LN was supermicrosurgically anastomosed to the contralateral iliac lymphatic vessel that was subcutaneously transferred to the left groin. Postoperatively, the patient experienced no episode of cellulitis with reduced degree of compression treatment, and lymphedematous volume decreased from 306 to 264 in terms of LEL index. Postoperative ICG lymphography showed evidence of reconstructed lymph flow from the left foot to the left groin and to the right inguinal LN through the transplanted LN flap and the ELLA. There were no subjective or objective findings of donor site lymphedema of the left arm or the right back and the lower extremity. True perforator LN flap with ELLA is a safe and effective treatment and has the potential to be a useful therapeutic option for primary unilateral LEL.
原发性下肢淋巴水肿（LEL）的治疗具有挑战性，淋巴结转移（LNT）可作为进行性LEL的一种治疗选择。然而，LNT存在供区淋巴水肿的风险，且由于输出淋巴管（ELV）阻塞可能导致淋巴结（LN）硬化。在此，我们报告首例采用带输出淋巴管-淋巴管吻合术（ELLA）的真皮下穿支LNT实现完全淋巴流重建，治疗一名原发性LEL并伴有严重淋巴管硬化的患者。一名49岁女性，患有原发性进行性单侧左下肢LEL，对保守治疗无效，频繁发生蜂窝织炎。在吲哚菁绿（ICG）淋巴造影导航下，从左侧胸壁区域选择性切取真皮下穿支LN皮瓣，通过穿支对穿支吻合术转移至左腹股沟。将移植LN的ELV在超显微手术下与皮下转移至左腹股沟的对侧髂淋巴管吻合。术后，患者未再发生蜂窝织炎，压迫治疗程度减轻，LEL指数显示淋巴水肿体积从306降至264。术后ICG淋巴造影显示存在从左脚经移植的LN皮瓣和ELLA至左腹股沟再至右腹股沟LN的重建淋巴流。左臂、右背部及下肢供区均未出现主观或客观的淋巴水肿表现。带ELLA的真皮下穿支LN皮瓣是一种安全有效的治疗方法，有可能成为原发性单侧LEL的一种有用治疗选择。
