Distally Based Lymphatic Microsurgical Preventive Healing Approach-A Modification of the Classic Approach.

IF 1.3 Q3 SURGERY Archives of Plastic Surgery-APS Pub Date : 2024-08-06 eCollection Date: 2024-09-01 DOI:10.1055/a-2336-0150
Allen Wei-Jiat Wong, Nadia Hui Shan Sim, Coeway Boulder Thing, Wenxuan Xu, Hui Wen Chua, Sabrina Ngaserin, Shermaine Loh, Yee Onn Kok, Jia Jun Feng, Tan Woon Woon Pearlie, Benita Kiat-Tee Tan
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Abstract

The treatment of breast cancer has seen great success in the recent decade. With longer survivorship, more attention is paid to function and aesthetics as integral treatment components. However, breast cancer-related lymphedema (BCRL) remains a significant complication. Immediate lymphatic reconstruction is an emerging technique to reduce the risk of BCRL, the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) being the most widely used approach. Despite promising results, it is often difficult to find suitably sized recipient venules and perform the microanastomoses between mismatched vessels deep in the axilla. Moreover, high axillary venous pressure gradients and potential damage from radiotherapy may affect the long-term patency of the anastomoses. From an ergonomic point of view, performing lymphaticovenular anastomosis in the deep axilla may be challenging for the microsurgeon. In response to these limitations, we modified the technique by moving the lymphatic reconstruction distally-terming it distally based LYMPHA (dLYMPHA). A total of 113 patients underwent mastectomy with axillary clearance in our institution from 2018 to 2021. Of these, 26 underwent subsequent dLYMPHA (Group 2), whereas 87 did not (Group 1). In total, 17.2% (15 patients) and 3.84% (1 patient) developed BCRL in Groups 1 and 2, respectively ( p  = 0.018). Lymphatics and recipient venules suitable for anastomoses can be reliably found in the distal upper limb with better size match. A distal modification achieves a more favorable lymphaticovenular pressure gradient, vessel match, and ergonomics while ensuring a comparably low BCRL rate.

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基于远端淋巴显微外科预防性愈合方法--经典方法的改进
近十年来,乳腺癌的治疗取得了巨大成功。随着存活期的延长,人们更加关注功能和美学,将其作为治疗的组成部分。然而,乳腺癌相关淋巴水肿(BCRL)仍然是一个重要的并发症。即时淋巴重建是一种新兴的技术,可降低乳腺癌淋巴水肿的风险,淋巴显微外科预防性愈合方法(LYMPHA)是目前应用最广泛的方法。尽管效果很好,但通常很难找到大小合适的受体静脉,也很难在腋窝深处不匹配的血管之间进行微吻合。此外,高腋窝静脉压力梯度和放疗可能造成的损伤也会影响吻合口的长期通畅性。从人体工程学的角度来看,在腋窝深部进行淋巴管-静脉吻合术对显微外科医生来说可能具有挑战性。针对这些局限性,我们对该技术进行了改进,将淋巴重建移至远端,并将其命名为远端淋巴孔吻合术(dLYMPHA)。从2018年到2021年,我院共有113名患者接受了腋窝清扫乳房切除术。其中,26 人接受了后续的 dLYMPHA(第 2 组),而 87 人未接受(第 1 组)。第 1 组和第 2 组分别有 17.2%(15 名患者)和 3.84%(1 名患者)发生 BCRL(P = 0.018)。适合吻合的淋巴管和受体静脉可以在上肢远端可靠地找到,且大小匹配度更高。远端改造可实现更有利的淋巴-静脉压力梯度、血管匹配和人体工程学,同时确保较低的 BCRL 发生率。
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CiteScore
2.10
自引率
6.70%
发文量
131
审稿时长
10 weeks
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