From the Department of Plastic and Reconstructive Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S391-S394. doi: 10.1097/SAP.0000000000003452.
Breast cancer-related lymphedema (BCRL) is a limiting sequelae of breast cancer treatment that may negatively impact 30% to 50% of high-risk breast cancer survivors. Risk factors for development of BCRL include axillary lymph node dissection (ALND), and recently, axillary reverse lymphatic mapping and immediate lymphovenous reconstruction (ILR) at time of ALND have been implemented to prevent BCRL. Reliable anatomy of neighboring venules has been commented on in the literature; however, little information exists about anatomical location of local lymphatic channels amenable for bypass.
After institutional review board approval, patients who underwent ALND with axillary reverse lymphatic mapping and ILR at a tertiary cancer center from November 2021 to August 2022 were applicable for this study. The location and number of lymphatic channels used for ILR were identified and measured intraoperatively with the arm abducted to 90 degrees and soft tissue under no tension. Four measurements were taken to localize each lymphatic and were based on relationship with reliable anatomic landmarks including 4th rib, anterior axillary line, and lower border of the pectoralis major muscle. Demographics, oncologic treatments, intraoperative factors, and outcomes were prospectively maintained.
Twenty-seven patients met inclusion for this study by August 2022 with a total of 86 lymphatic channels identified. Patients were on average 50 ± 12 years old with a body mass index of 30 ± 6 and had an average of 1 vein and 3 identifiable lymphatic channels amenable to bypass. Seventy percent of lymphatic channels were found in a cluster of 2 or more channels. The average horizontal location was 4.5 ± 1.4 cm lateral to the 4th rib. The average vertical location was 1.3 ± 0.9 cm from the superior border of the 4th rib.
These data comment upon intraoperatively identified and consistent location of upper extremity lymphatic channels used for ILR. These lymphatic channels are often found in clusters with 2 or more lymphatic channels at the same location. Such insight may aid in easier intraoperative identification of amenable vessels for the unexperienced surgeon, decrease in intraoperative time, and higher success of ILR.
乳腺癌相关淋巴水肿（BCRL）是乳腺癌治疗的一种限制后遗症，可能会对 30%至 50%的高危乳腺癌幸存者产生负面影响。BCRL 的发展风险因素包括腋窝淋巴结清扫术（ALND），最近，在 ALND 时实施腋窝反向淋巴映射和即刻淋巴静脉重建（ILR）已被用于预防 BCRL。文献中已经评论了邻近小静脉的可靠解剖结构；然而，关于可用于旁路的局部淋巴管的解剖位置的信息很少。
在机构审查委员会批准后，从 2021 年 11 月至 2022 年 8 月，在一家三级癌症中心接受 ALND 联合腋窝反向淋巴映射和 ILR 的患者符合本研究条件。术中在手臂外展 90 度且软组织无张力的情况下，识别并测量用于 ILR 的淋巴管的位置和数量。为了定位每个淋巴管，进行了 4 次测量，并基于与可靠解剖学标志（第 4 肋、腋前线和胸大肌下缘）的关系进行定位。前瞻性地记录了人口统计学、肿瘤学治疗、术中因素和结果。
到 2022 年 8 月，共有 27 名患者符合本研究纳入标准，共识别出 86 条淋巴管。患者平均年龄为 50 ± 12 岁，体重指数为 30 ± 6，有 1 条静脉和 3 条可用于旁路的可识别淋巴管。70%的淋巴管位于 2 个或更多淋巴管的集群中。平均水平位置位于第 4 肋外侧 4.5 ± 1.4cm。平均垂直位置距离第 4 肋上缘 1.3 ± 0.9cm。
这些数据评论了术中识别的和一致的用于 ILR 的上肢淋巴管的位置。这些淋巴管通常位于集群中，同一位置有 2 个或更多淋巴管。这种见解可能有助于经验不足的外科医生更容易地识别可用于手术的血管，减少手术时间，并提高 ILR 的成功率。
