Visconti Giuseppe, Bianchi Alessandro, Salgarello Marzia, Di Leone Alba, Hayashi Akitatsu, Masetti Riccardo, Franceschini Gianluca
Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del "Sacro Cuore", Largo A. Gemelli 8, 00168 Roma, Italy.
Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
J Pers Med. 2022 Aug 21;12(8):1346. doi: 10.3390/jpm12081346.
The modern concept of lymphatic transfer includes vascularised lymph node transfer (VLNT), lymphatic vessels transfer (lymph interpositional flap transfer, LIFT) and lymphatic system transfer (vascularised lymph nodes and afferent lymphatics, LYST). The aim of this paper was to report our experience with different types of lymphatic transfer.
From June 2016 to June 2020, 30 consecutive patients affected by extremity lymphedema and 15 patients affected by post-traumatic lower extremity soft tissue defects, underwent lymphatic transfer (VLNT, LYST or LIFT). All cases were preoperatively evaluated by both high frequency and ultra-high frequency ultrasound. Flap features were recorded, as well as qualitative and quantitative outcomes at 1 year postoperative.
The mean postoperative lymphedema index reduction was 7.2 ± 5.7 for upper extremity and 20.7 ± 7.1 for lower extremity. No dismission of compression garments occurred, 12 patients (26%) referred more stable results of physical treatment and 1 case showed a 1-class compression reduction. All the LIFTs aimed as preventive did not develop post-traumatic lymphedema. In all cases of distal placement of VLNT and/or LYST, patients were dissatisfied with the aesthetic appearance of reconstruction, while no donor site scar disappointment was referred.
When LVA is not feasible, LTT may represent a valid treatment option. This report was aimed at comprehensively describing and assessing how different lymphatic tissue transfer modalities may fulfil the different reconstructive needs of lymphedema patients.
现代淋巴转移概念包括带血管蒂淋巴结转移（VLNT）、淋巴管转移（淋巴组织植入皮瓣转移，LIFT）和淋巴系统转移（带血管蒂淋巴结及输入淋巴管，LYST）。本文旨在报告我们在不同类型淋巴转移方面的经验。
2016年6月至2020年6月，30例连续性肢体淋巴水肿患者和15例创伤后下肢软组织缺损患者接受了淋巴转移（VLNT、LYST或LIFT）。所有病例术前均接受高频和超高频超声评估。记录皮瓣特征以及术后1年的定性和定量结果。
上肢术后淋巴水肿指数平均降低7.2±5.7，下肢为20.7±7.1。无弹力袜停用情况，12例患者（26%）称物理治疗效果更稳定，1例患者压迫等级降低1级。所有预防性LIFT均未发生创伤后淋巴水肿。在所有VLNT和/或LYST远端放置的病例中，患者对重建后的美观效果不满意，而未提及供区瘢痕问题。
当淋巴管吻合不可行时，淋巴组织转移可能是一种有效的治疗选择。本报告旨在全面描述和评估不同的淋巴组织转移方式如何满足淋巴水肿患者不同的重建需求。
