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Title: Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema
Authors: Fabio Nicoli
Joannis Constantinides
Pedro Ciudad
Stamatis Sapountzis
Kidakorn Kiranantawat
Davide Lazzeri
Seong Yoon Lim
Marzia Nicoli
Pei Yu Chen
Matthew Sze Wei Yeo
Ram M. Chilgar
Hung Chi Chen
China Medical University Hospital Taichung
Universita degli Studi di Roma Tor Vergata
Guy's and St Thomas' NHS Foundation Trust
Mahidol University
Villa Salaria Clinic
Maharashtra University of Health Sciences
Keywords: Medicine
Issue Date: 1-May-2015
Citation: Lasers in Medical Science. Vol.30, No.4 (2015), 1377-1385
Abstract: © 2015, Springer-Verlag London. Upper limb lymphedema following breast cancer surgery is a challenging problem for the surgeon. Lymphatico-venous or lymphatico-lymphatic anastomoses have been used to restore the continuity of the lymphatic system, offering a degree of improvement. Long-term review indicates that lumen obliteration and occlusion at the anastomosis level commonly occurs with time as a result of elevated venous pressure. Lymph node flap transfer is another microsurgical procedure designed to restore lymphatic system physiology but does not provide a complete volume reduction, particularly in the presence of hypertrophied adipose tissue and fibrosis, common in moderate and advanced lymphedema. Laser-assisted liposuction has been shown to effectively reduce fat and fibrotic tissues. We present preliminary results of our practice using a combination of lymph node flap transfer and laser-assisted liposuction. Between October 2012 and May 2013, ten patients (mean 54.6 ± 9.3 years) with moderate (stage II) upper extremity lymphedema underwent groin or supraclavicular lymph node flap transfer combined with laser-assisted liposuction (high-power diode pulsed laser with 1470-nm wavelength, LASEmaR 1500-EUFOTON, Trieste, Italy). A significant decrease of upper limb circumference measurements at all levels was noted postoperatively. Skin tonicity was improved in all patients. Postoperative lymphoscintigraphy revealed reduced lymph stasis. No patient suffered from donor site morbidity. Our results suggest that combining laser liposuction with lymph node flap transfer is a safe and reliable procedure, achieving a reduction of upper limb volume in treated patients suffering from moderate upper extremity lymphedema.
ISSN: 1435604X
Appears in Collections:Scopus 2011-2015

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