Leppäpuska Ida-Maria, Suominen Erkki, Viitanen Tiina, Rannikko Eeva, Visuri Mikko, Mäki Maija, Saarikko Anne, Hartiala Pauliina
From the Departments of Plastic and General Surgery.
Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku.
Ann Plast Surg. 2019 Sep;83(3):308-317. doi: 10.1097/SAP.0000000000001828.
Upper limb lymphedema is a common problem after axillary lymph node dissection. Lymphatic drainage can be improved by microvascular lymph node transfer, whereas liposuction can be used to reduce arm volume and excess of adipose tissue. We present the results of chronic lymphedema patients who have undergone lymph node transfer and liposuction simultaneously in 1 operation and compare the results with patients who have undergone lymph node transfer without liposuction.
During May 2007 to February 2015, 20 postmastectomy patients and 1 Hodgkin's lymphoma patient presenting with chronic nonpitting lymphedema (age between 37 and 74 years, average 56.7 years) were operated using the combined technique and 27 postmastectomy patients presenting with early-stage lymphedema (age between 31 and 68 years, average age 50.2 years) were operated using only the lymph node transfer. Compression therapy was started immediately after the operation and the patients used compression 24 h/d at least 6 months postoperatively. Changes in clinical parameters (number of erysipelas infections, pain), arm volume, transport indexes calculated form lymphoscintigraphy images, and daily usage of compression garments were compared preoperatively and postoperatively and between groups (combined technique vs lymph node transfer). The study was a retrospective observational study.
In the combined technique group, the average arm volume excess decreased postoperatively 87.7%, and in 7 of 10 patients, the edema volume did not increase even without compression. Seventeen of 21 patients were able to reduce the use of compression garment. Lymphoscintigraphy results were improved in 12 of 15 patients and the improvement was significantly greater in the combined technique group than in the lymph node transfer group (P = 0.01). The number of erysipelas infections was decreased in 7 of 10 patients and the decrease was significantly greater in the combined technique group than in the lymph node transfer group (P = 0.02). In the lymph node transfer group, the average excess volume decreased postoperatively 27.5%. Fourteen of 27 patients were able to reduce the use of compression garments. Lymphoscintigraphy results were improved in 8 of 19 patients, and the number of erysipelas infections was decreased in 1 of 3 patients.
Liposuction can safely be performed with lymph node transfer in 1 operation to achieve optimal results in patients with chronic lymphedema. The combined technique provides immediate volume reduction and further regenerative effects on the lymphatic circulation. The significantly greater reduction in lymphoscintigraphy values and erysipelas infections suggests that the combined technique might be better for late-stage lymphedema patients than lymph node transfer alone.
上肢淋巴水肿是腋窝淋巴结清扫术后的常见问题。微血管淋巴结转移可改善淋巴引流，而吸脂术可用于减少手臂体积和多余脂肪组织。我们展示了在同一手术中同时接受淋巴结转移和吸脂术的慢性淋巴水肿患者的结果，并将其与仅接受淋巴结转移的患者的结果进行比较。
2007年5月至2015年2月期间，20例乳房切除术后患者和1例患有慢性非凹陷性淋巴水肿的霍奇金淋巴瘤患者（年龄在37至74岁之间，平均56.7岁）采用联合技术进行手术，27例患有早期淋巴水肿的乳房切除术后患者（年龄在31至68岁之间，平均年龄50.2岁）仅采用淋巴结转移进行手术。术后立即开始压迫治疗，患者术后至少6个月每天使用压迫装置24小时。比较术前和术后以及两组（联合技术组与淋巴结转移组）之间临床参数（丹毒感染次数、疼痛）、手臂体积、从淋巴闪烁造影图像计算得出的转运指数以及压迫衣物的每日使用情况的变化。该研究为回顾性观察研究。
在联合技术组中，术后平均手臂多余体积减少了87.7%，10例患者中有7例即使不使用压迫装置，水肿体积也未增加。21例患者中有17例能够减少压迫衣物的使用。15例患者中有12例淋巴闪烁造影结果得到改善，联合技术组的改善明显大于淋巴结转移组（P = 0.01）。10例患者中有7例丹毒感染次数减少，联合技术组的减少明显大于淋巴结转移组（P = 0.02）。在淋巴结转移组中，术后平均多余体积减少了27.5%。27例患者中有14例能够减少压迫衣物的使用。19例患者中有8例淋巴闪烁造影结果得到改善，3例患者中有1例丹毒感染次数减少。
吸脂术可在同一手术中与淋巴结转移安全地联合进行，以在慢性淋巴水肿患者中取得最佳效果。联合技术可立即减少体积，并对淋巴循环产生进一步的再生作用。淋巴闪烁造影值和丹毒感染次数的显著更大程度减少表明，联合技术可能比单独的淋巴结转移对晚期淋巴水肿患者更好。
