Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
J Plast Reconstr Aesthet Surg. 2021 Nov;74(11):2856-2862. doi: 10.1016/j.bjps.2021.03.112. Epub 2021 Apr 18.
Changes of the lymph flow from the chest wall after mastectomy and sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (Ax) has yet to be understood. This study aimed to investigate the effect of axillary surgery on lymphatic flow from the chest wall in patients who have undergone mastectomy, including those have undergone breast reconstruction and vascularized lymph node transfer (VLNT).
Following mastectomy in 100 breasts, the directions of lymph flow from the chest wall was compared between the SLNB omission, SLNB, Ax, and Ax followed by VLNT groups using indocyanine green (ICG) lymphography in cross-sectional study. Lymph flow on the deep epigastric artery perforator (DIEP) flap was also investigated.
Lymph flow directing to the ipsilateral axilla was observed more frequently after SLNB than Ax (48% vs. 12.5%; p = 0.005); however, no significant difference was observed in the frequency of contralateral axillary route adoption between them (8% vs. 15%; p = 0.65). In the VLNT group, lymph flow to the ipsilateral axilla was not observed at a significantly higher frequency than in the Ax group (12.5% vs. 12.5%, p = 1.00). On the transferred DIEP flap, the lymph flowed anterograde or retrograde parallel to the anatomic course of the lymphatic vessels.
To visualize the direction of lymph flow of the chest following mastectomy, ICG lymphography may be useful to discern the direction in which malignant neoplasms, including lymphoma, are transported and to plan for lymph flow restoration.
乳腺癌根治术和前哨淋巴结活检（SLNB）或腋窝淋巴结清扫（Ax）后，来自胸壁的淋巴液流动变化尚未被理解。本研究旨在调查腋窝手术后对接受过乳腺癌根治术患者胸壁淋巴液流动的影响，包括接受过乳房重建和血管化淋巴结转移（VLNT）的患者。
在 100 例乳房中进行乳腺癌根治术后，通过吲哚菁绿（ICG）淋巴造影术，在横断面研究中比较 SLNB 省略、SLNB、Ax 和 Ax 后行 VLNT 组中来自胸壁的淋巴液流动方向。还研究了腹壁下动脉穿支（DIEP）皮瓣上的淋巴流量。
与 Ax 相比，SLNB 后更频繁地观察到向同侧腋窝的淋巴流（48%对 12.5%；p=0.005）；然而，它们之间对侧腋窝途径的采用频率没有显著差异（8%对 15%；p=0.65）。在 VLNT 组中，向同侧腋窝的淋巴流量并不比 Ax 组更高（12.5%对 12.5%，p=1.00）。在转移的 DIEP 皮瓣上，淋巴液沿淋巴管的解剖路径向前或向后流动。
为了可视化乳腺癌根治术后胸壁淋巴液流动的方向，ICG 淋巴造影术可能有助于辨别恶性肿瘤（包括淋巴瘤）的运输方向，并规划淋巴液流动的恢复。
