Ciudad Pedro, Manrique Oscar J, Adabi Kian, Huang Tony Chieh-Ting, Agko Mouchammed, Trignano Emilio, Chang Wei-Ling, Chen Tsung-Wei, Salgado Christopher J, Chen Hung-Chi
Department of Plastic and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Department of Plastic and Reconstructive Surgery, National Cancer Institute of Peru (INEN), Lima, Peru.
J Surg Oncol. 2019 Mar;119(4):439-448. doi: 10.1002/jso.25360. Epub 2019 Jan 4.
Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals.
Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed.
All flaps survived. The mean follow-up period was 14.2 months (range, 12-19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7-fold quality-of-life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases.
Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients' quality of life in the advanced stages of lymphedema.
晚期淋巴水肿的治疗不仅需要恢复生理性淋巴引流，还需要切除纤维化组织和多余皮肤。本研究的目的是展示双血管化淋巴结转移（VLNT）与保留穿支的改良根治性减容术（RRPP）相结合如何实现这两个治疗目标。
2010年至2016年期间，16例（15例女性，1例男性）肢体淋巴水肿患者接受了双胃网膜VLNT与改良RRPP联合手术。分析了人口统计学数据、包括周长减少率在内的结果、术前和术后淋巴闪烁显像、并发症以及对淋巴水肿生活质量（LYMQOL）问卷的回答。
所有皮瓣均存活。平均随访期为14.2个月（范围12 - 19个月）。上肢平均周长减少率为74.5%±6.9%，下肢为68.0%±4.2%。无重大并发症。包括麻木和感觉过敏在内的轻微并发症采用保守治疗。LYMQOL显示生活质量提高了2.7倍（P < 0.01）。术后淋巴闪烁显像显示所有病例的淋巴引流均有改善。
双VLNT与改良RRPP联合手术安全有效地改善了淋巴引流，减少了纤维化组织和多余皮肤，减少了感染发作次数，并改善了晚期淋巴水肿患者的生活质量。
