Perforator-to-Perforator SCIP-Based Vascularized Lymphnode Transfer to Reduce Morbidity and Increase Efficacy in Lymphedema Surgery: Preliminary Results With 12 Cases

IF 1.5 3区 医学 Q3 SURGERY Microsurgery Pub Date : 2024-10-16 DOI:10.1002/micr.31249
Matteo Meroni, Mario F. Scaglioni
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Abstract

Background

Vascularized lymphnode transfer (VLNT) is one of the most common surgical treatments for moderate and severe lymphedema. Various techniques have been described for harvesting lymph nodes from different donor sites. However, a standardized harvest procedure is still lacking. The transplantation of inguinal lymph nodes using the perforator-to-perforator technique may represent a significant advancement in this context. This approach relies always on the same vascular pedicle, offers a lower morbidity, and allows for a more superficial inset at the recipient site.

Patients and Methods

Between 2019 and 2022, 12 patients received a perforator-to-perforator VLNT for the treatment of late stage (Late II) lymphedema, both primary and secondary. In all cases, the lymphnodes were harvested from the groin supplied by the superficial circumflex iliac artery perforator (SCIP) vessels. The average age was 62.2 years old (range 47–73 years old); nine patients were females and three were males. In 11 cases, the lower limb was affected, and in one case, the upper limb was affected. Eight patients received additional lymphovenous anastomosis.

Results

All the patients reported an improvement of the symptoms after surgery in terms of tissue quality (tenderness, lymphangiectasia, and pain), and no cases of recurrent cellulitis were reported. Postoperative lymphoscintigraphy was performed at 6 months, and in all cases, the function of transplanted lymphnodes was confirmed. No complications were encountered, neither at donor nor at recipient site. The follow-up was at least 12 months in all patients.

Conclusions

Despite being more technically demanding, the systematic implementation of the perforator-to-perforator technique for the transfer of SCIP-based inguinal lymphnodes can be a valuable evolution of VLNT. The aim of this study is to present how this technical approach may become a standardized procedure for inguinal-based VLNT, offering a reduced donor and recipient site morbidity and potentially enhancing the lymph draining effects due to a more superficial inset.

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基于穿孔器对穿孔器 SCIP 的血管淋巴结转移,降低淋巴水肿手术的发病率并提高疗效:12 例病例的初步结果
背景血管化淋巴结转移(VLNT)是治疗中度和重度淋巴水肿最常见的手术疗法之一。从不同的供体部位获取淋巴结的技术多种多样。然而,目前仍缺乏标准化的淋巴结摘取程序。使用穿孔器对穿孔器技术移植腹股沟淋巴结可能是这方面的一大进步。这种方法始终依靠相同的血管蒂,发病率较低,而且可以在受体部位进行更浅表的插入。 患者和方法 2019年至2022年间,12名患者接受了穿孔器对穿孔器VLNT治疗晚期(晚II期)淋巴水肿,包括原发性和继发性淋巴水肿。在所有病例中,淋巴结都是从腹股沟由髂浅周动脉穿孔(SCIP)血管供应的淋巴结中提取的。患者平均年龄为 62.2 岁(47-73 岁不等),其中九名女性,三名男性。11例患者下肢受累,1例患者上肢受累。八名患者接受了额外的淋巴管吻合术。 结果 所有患者均表示术后在组织质量(触痛、淋巴管扩张和疼痛)方面症状有所改善,没有复发蜂窝组织炎的病例。术后 6 个月进行了淋巴管造影,所有病例都证实了移植淋巴结的功能。供体和受体部位均未出现并发症。所有患者均接受了至少 12 个月的随访。 结论 尽管穿孔器对穿孔器技术的技术要求较高,但系统地实施穿孔器对穿孔器技术来转移 SCIP 腹股沟淋巴结是 VLNT 的重要发展。本研究的目的是介绍这种技术方法如何成为腹股沟 VLNT 的标准化手术,从而降低供体和受体部位的发病率,并通过更浅的插入提高淋巴引流效果。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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