De Santis Giorgio, Saxena Bharat, Starnoni Marta, Pappalardo Marco, Jacob Vinay
From the Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, Policlinico University Hospital, University of Modena and Reggio Emilia.
Department of Plastic Surgery, Gokuldas Tejpal Hospital and Grant Government Medical College.
Plast Reconstr Surg. 2023 May 1;151(5):850e-856e. doi: 10.1097/PRS.0000000000010046. Epub 2022 Dec 23.
Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. FLE traditionally has been managed with antibiotics and decongestive therapy (DCT) in the early stage or excisional surgery at the late stage. Results of vascularized lymph node transfer (VLNT) in postoncologic lymphedema have been encouraging, and VLNT is a widely accepted surgical treatment. The authors advocate that the combined treatment of antibiotics, DCT, and vascularized submental lymph node (VSLN) transfer could produce objective and subjective improvement of early-stage lower limb FLE.
Between January of 2019 and January of 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire.
Three men and one woman with an average age of 27 years (range, 25 to 29 years) were included. Two patients presented bilateral lymphedema. One patient was lost at 3-month follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements after antibiotics and DCT of 2074 ± 471 cc (39% ± 9%). At a mean follow-up of 12.3 ± 6.2 months, further improvement of limb volume of 2389 ± 576 cc (45% ± 10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow and none of the patients had episodes of postoperative cellulitis. Patients reported excellent outcome on subjective scoring (average score, 9 ± 1) and returned to their daily activities without wearing compression garments.
The authors' early experience showed that VSLN transfer may represent an effective treatment option in the multimodal approach to early-stage lower limb FLE.
丝虫性淋巴水肿（FLE）是继发性淋巴水肿最常见的病因，在发展中国家呈地方性流行。传统上，FLE在早期采用抗生素和减充血治疗（DCT），晚期采用切除手术。肿瘤后淋巴水肿的带血管淋巴结转移（VLNT）结果令人鼓舞，VLNT是一种广泛接受的手术治疗方法。作者主张，抗生素、DCT和带血管颏下淋巴结（VSLN）转移联合治疗可使早期下肢FLE在客观和主观上得到改善。
回顾性分析2019年1月至2020年1月期间接受VLNT的早期下肢FLE患者。所有患者均从颏下区域获取VSLN。通过体积改善、蜂窝织炎发生频率、淋巴闪烁显像以及主观评分问卷来评估结果。
纳入3名男性和1名女性，平均年龄27岁（范围25至29岁）。2例患者为双侧淋巴水肿。1例患者在3个月随访时失访，未纳入分析。患者在接受抗生素和DCT后，初始周径测量值减少2074±471 cc（39%±9%）。平均随访12.3±6.2个月时，VSLN转移后肢体体积进一步改善2389±576 cc（45%±10%）。淋巴闪烁显像显示VLNT摄取染料，真皮反流减少，且所有患者均未发生术后蜂窝织炎。患者主观评分结果良好（平均评分9±1），无需穿戴加压服装即可恢复日常活动。
作者的早期经验表明，VSLN转移可能是早期下肢FLE多模式治疗中的一种有效治疗选择。
