Ciudad Pedro, Sabbagh M Diya, Agko Mouchammed, Huang Tony C T, Manrique Oscar J, L Carmen Román, Reynaga Cesar, Delgado Ricardo, Maruccia Michele, Chen Hung-Chi
Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Indian J Plast Surg. 2019 Jan;52(1):81-92. doi: 10.1055/s-0039-1688537. Epub 2019 May 14.
Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.
淋巴水肿是指富含蛋白质的液体在组织间隙中积聚。这可能继发于淋巴管或淋巴结的先天性畸形，或因损伤破坏了正常形成的淋巴管和淋巴结而发生。停滞的、富含蛋白质的淋巴液引发炎症反应，导致脂肪细胞增殖、纤维组织沉积，并增加感染易感性。最终结果是永久性畸形和皮肤改变。早期准确诊断至关重要，因为淋巴水肿是一个慢性进行性问题。当淋巴水肿累及下肢时，以保留功能和活动能力的方式进行处理很重要。早期诊断还允许采取积极而非被动的治疗方法，并采用新的生理手术，如淋巴静脉吻合术和带血管蒂淋巴结转移术。此类干预措施通过让外科医生挽救剩余的功能性淋巴管来减缓疾病进展并降低发病率。当生理手术失败或出现延迟就诊时，增加切除手术可对这种使人衰弱的疾病提供更全面的治疗。本文旨在综述下肢淋巴水肿外科治疗的最新概念。
