Shrout Max A, Plonkowski Alexander T, Morris Bryn E, Flug Jonathan A, Rebecca Alanna M
From the Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, Ariz.
School of Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
Plast Reconstr Surg Glob Open. 2024 Nov 18;12(11):e6305. doi: 10.1097/GOX.0000000000006305. eCollection 2024 Nov.
Lymphedema is a frequent complication of breast cancer treatment. As the survival rates of breast cancer continue to increase, the number of women with lymphedema will also increase. Surgical treatment of lymphedema has made significant advances during the past 20 years, and our understanding of these procedures continues to evolve. Vascularized lymph node transfer is an increasingly popular option for surgical treatment of lymphedema; however, the mechanism behind symptomatic relief is not fully understood. A proposed theory for improvement in lymphedema symptoms is lymphangiogenesis and spontaneous regeneration of lymphatic vessels, the timing and degree of which are not well defined. We present the case of a 40-year-old woman with a 10-year history of right upper extremity lymphedema secondary to bilateral mastectomy and right axillary lymph node dissection, who subsequently underwent vascularized omental lymph node transfer and lymphovenous bypass with radiographic evidence of spontaneous lymphatic reconnection within 9 months. To our knowledge, this is the earliest reported radiographic evidence of lymphatic regeneration in a human subject to date, adding to the growing body of evidence to support the therapeutic benefits of vascularized lymph node transfers.
淋巴水肿是乳腺癌治疗常见的并发症。随着乳腺癌生存率持续提高，患淋巴水肿的女性人数也会增加。在过去20年里，淋巴水肿的外科治疗取得了重大进展，我们对这些手术的认识也在不断发展。带血管蒂淋巴结转移术是治疗淋巴水肿越来越常用的手术方式；然而，症状缓解背后的机制尚未完全明确。一种关于淋巴水肿症状改善的理论是淋巴管生成和淋巴管的自发再生，但其时机和程度尚不明确。我们报告一例40岁女性，因双侧乳房切除术和右侧腋窝淋巴结清扫术后出现右上肢淋巴水肿10年，随后接受了带血管蒂网膜淋巴结转移术和淋巴静脉旁路手术，9个月内影像学显示有自发淋巴管再通。据我们所知，这是迄今为止人类受试者中最早报道的淋巴管再生影像学证据，为支持带血管蒂淋巴结转移术的治疗益处增添了越来越多的证据。
