Dionyssiou Dimitrios, Tsimponis Antonios, Georgiadou Eleni, Mamaligka Konstantina, Demiri Efterpi
Department of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, Greece.
JPRAS Open. 2024 Dec 2;43:328-339. doi: 10.1016/j.jpra.2024.11.019. eCollection 2025 Mar.
Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial cell migration toward the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aimed to examine the hypothesis that nanofibrillar collagen scaffolds (NCS) combined with VLNT can provide guided lymphagiogenesis creating long-lasting lymphatic pathways.
Twenty-four patients (21 female, 3 male) underwent a lymphatic microsurgery for upper ( = 11) or lower ( = 13) limb secondary lymphedema and completed at least 18 months follow-up were selected and equally divided in 2 groups; Group-A underwent VLNT, Group-B underwent combined VLNT and NCS procedure. Lymph node flap sizes, harvesting procedure, and implantation location were similar in both groups. Demographics, lymphedema etiology and staging, limb volumetry, and somatometric data were recorded. Pre- and post-operative data for limb-volume difference, infection episodes/year, and indocyanine-green (ICG) lymphography changes were documented in all patients.
Mean follow-up was period was 42 months (24-60 months) in Group-A, and 27 months (18-48 months) in Group-B patients. Demographic data, lymphedema etiology, and staging were comparable in both groups. Pre- and post-operative edema volume difference for Group-A was 36 % and 25 % ( < 0.001), and 33 % and 14 % in Group-B ( = 0.001), respectively. The mean number of infection episodes decreased in Group-A and B from 1.75 to 0.33 and from 2.17 to 0.42 per patient/year, respectively. ICG mean stage in Group-A was 3.58 pre- and 3 post-operatively ( = 0.045), and 3.67 pre- and 2.08 post-operatively in Group-B ( = 0.506). A statistically significant difference was found in post-operative volume difference between the 2 groups ( = 0.008) and post-operative ICG changes ( < 0.001). ICG-lymphography demonstrated new lymphatic vessel formation at the NCS implantation location.
Long-term follow-up of the patients treated using combined VLNT-NCS approach revealed a statistically significant improvement regarding volume reduction, infection episodes per year, ICG downstaging, and new lymphatic vessel formation, compared to VLNT alone.
带血管蒂淋巴结转移术（VLNT）可加速生长因子分泌，促使淋巴管内皮细胞向间质流方向迁移，并以多向模式促进淋巴管生成。我们的观察性研究旨在检验以下假设：纳米纤维胶原支架（NCS）联合VLNT可引导淋巴管生成，创建持久的淋巴通路。
选择24例患者（21例女性，3例男性），他们因上肢（n = 11）或下肢（n = 13）继发性淋巴水肿接受了淋巴显微手术，并完成了至少18个月的随访，将其平均分为2组；A组接受VLNT，B组接受VLNT联合NCS手术。两组的淋巴结瓣大小、采集过程和植入位置相似。记录人口统计学、淋巴水肿病因和分期、肢体容积测量和人体测量数据。记录所有患者术前和术后的肢体容积差异、每年感染发作次数以及吲哚菁绿（ICG）淋巴管造影变化的数据。
A组患者的平均随访期为42个月（24 - 60个月），B组患者为27个月（18 - 48个月）。两组的人口统计学数据、淋巴水肿病因和分期具有可比性。A组术前和术后水肿容积差异分别为36%和25%（P < 0.001），B组分别为33%和14%（P = 0.001）。A组和B组患者每年的平均感染发作次数分别从1.75次降至0.33次和从2.17次降至0.42次。A组ICG平均分期术前为3.58，术后为3（P = 可见 0.045），B组术前为3.67，术后为2.08（P = 0.506）。两组术后容积差异（P = 0.008）和术后ICG变化（P < 0.001）存在统计学显著差异。ICG淋巴管造影显示在NCS植入部位有新的淋巴管形成。
与单纯VLNT相比，对采用VLNT - NCS联合方法治疗的患者进行长期随访发现，在体积缩小、每年感染发作次数、ICG分期降低和新淋巴管形成方面有统计学显著改善。
