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Lymph Vessel Transplant

During this past year, we had quite a discussion on two newer concepts in the treatment and management of lymphedema.

These two treatments are lymph vessel transplant and lymph node transplant.

In truth, the concept is not new and I found an article first published in 1981 proposes lymph vessel transplantation and subsequently an experiment on dogs.

Obviously, after the passage of twenty six years, if this method were successful, we would have heard more about it and more research information would have been published.

It is my personal opinion, that in the long term, these two methods might well prove more dangerous then beneficial and I would be opposed to their use.

First, one of the biting questions of lymphedema research is “why is it that 60% of breast cancer patients do NOT get lymphedema?”

Research in that area proposes that perhaps those that DO get lymphedema already have a compromised or “at risk” lymph system.

Thus by removing lymph vessels or nodes from one area to reimplant in another simply makes a trade on the location of the at risk area, so what actually is gained or what is the benefit for the patient?

One study following transplant was done eight years after the surgical procedure. However, it is important to realize that lymphedema does not automatically appear immediately after the removal or destruction of either lymphatic vessels, tissue or nodes.

Many times it doesn’t appear for ten or more years. So clearly, more research and study needs to be done on these two techniques.

Once it does occur, however, it is at this time a life long condition with no cure..

In the meantime, I simply can not recommend it.

Be safe – be well.

Pat

Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation

24 Nov 2011

Gunther Felmerer M.D., Thorsten Sattler M.D., Christian Lohrmann M.D., Dalia Tobbia MB, M.D., MRCS

Abstract

Chronic lymphedema is a debilitating complication of cancer diagnosis and therapy and poses many challenges for health care professionals. It remains a poorly understood condition that has the potential to occur after any intervention affecting lymph node drainage mechanism. Microsurgical lymph vessel transplantation is increasingly recognized as a promising method for bypassing the obstructed lymph pathways and promoting long-term reduction of edema in the affected limb. A detailed review of 14 patients with postoperative lymphedema treated with autologous lymph vessel transplantation between October 2005 and November 2009 was performed. In this report, the authors gave an account of their experience in utilizing this operative method to alleviate secondary lymphedema including upper limb, lower limb, genital, and facial edemas. Lymph vessel transplantation enhanced lymphatic drainage in patients with secondary lymphedema. In the upper and lower extremities, three patients had completed symptomatic recovery and another nine patients achieved reasonable reduction of lymphedema, four of these needed no further lymph drainage or compression garments and the remaining maintained their improvement with further decongestive therapy with or without compression garments. The patients with facial and genital edemas also experienced significant symptomatic improvement. The authors were able to establish long-term patency of the lymph vessel anastomosis by magnetic resonance lymphangiography.

Wiley Online

The microsurgical lymph vessel transplantation

Handchir Mikrochir Plast Chir. 2003 Jul

Baumeister RG, Frick A. Plastische, Hand-, Mikrochirurgie, Chirurgische Klinik und Poliklinik - Grosshadern, Klinikum der Universität München, Germany. rbaumeis@gch.med.uni-muenchen.de

Key words Lymphedema - lymph vessel - microsurgery - transplantation

Using advanced microsurgical techniques, single lymph vessels can be safely anastomosed and segments of lymphatics can bridge localized lymphatic blockades which are mostly due to lymphadenectomies. Lymphatic grafts are harvested from the patient's thigh with a length up to about 30 cm. In the case of an axillary blockade they are anastomosed with ascending lymph vessels at the upper arm and lymph vessels at the supraclavicular region. Unilateral oedemas of lower extremities are treated by transferring the grafts via the symphysis and anastomosing them with ascending lymphatics at the affected side. Lymphoedemas of the penis and the scrotum as well as lymphoedemas due to a localized peripheral lymphatic blockade can be treated by lymphatic grafts. In 127 arm edemas the original difference in volume between the affected and the healthy arm was reduced at two third from 3368 cm (3) to 2567 cm(3) (p < 0.001). After a follow-up period of 2.6 years the volume was reduced to 2625 cm(3) (p < 0.001). The group of patients with a follow-up of at least ten years showed a volume of 2273 cm(3) (p < 0.001). The volume of unilateral lower extremity-lymphoedemas was reduced from 13 098 cm(3) to 10 578 cm(3) (p < 0.001) and showed a volume of 11 074 cm(3) after 1.7 years (p < 0.001) and 10 692 cm(3) after four years (p < 0.001). The original mean volume of the healthy contralateral leg was 9371 cm(3). Bridging localized gaps in the lymphatic system by autologous lymphatic grafts showed long lasting stable results. Starting the treatment of lymphoedemas by conservative procedures, one should not wait too long to ascertain the possibility of a microsurgical reconstruction in order to avoid increasing secondary tissue changes.

ThiemeConnect

Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema

Monday, May 16, 2005 Springer

Original Article Volume 5, Number 3 / May, 1981 – World Journal of Surgery

Rüdiger G. H. Baumeister1, 2 , Jürgen Scifert1, 2, Baldur Wiebecke1, 2 and Dietbert Hahn1, 2 (1) Department of Surgery, Institute for Surgical Research, Institute for Pathology, Munich, West Germany (2) Department of Radiology, University of Munich, Klinikum Grosshadern, Munich, West Germany

Abstract

Lymphedemas due to a blockage of the lymph vessels in the root of the extremities were treated experimentally and clinically by autotransplantation of lymph vessels under the operating microscope. In experimental lymphedema of the hind leg of 10 dogs, an increased circumference of about 50% was reduced to 10% within 7 weeks by lymph vessel transplantation. After removal of the transplants, the circumferences returned to pre-transplantation values. The pre-transplantation elevated intralymphatic pressure of 12.5 torr (controls: 2.5 torr) was reduced to the normal range of 3.5 torr after the transplantation. In 8 of 10 dogs, the patency of the transplants could be demonstrated by inspection, lymphography, and isotope injections. In all 10 dogs, patency could be proved by histologic examination. The data indicate that lymph vessel transplantation can restore the diminished lymph-transporting capacity brought on by lymphedema.

In 2 patients, it was possible to prepare lymph collectors about 25 cm long. After the transplantation, the circumferences diminished. By isotopes improved lymphatic transport could be demonstrated after the operation. Autologous transplantation of lymph vessels is a promising method for the treatment of secondary lymphedema especially in the early stages.

Springer Link

Planning and monitoring of autologous lymph vessel transplantation by means of nuclear medicine lymphoscintigraphy

Handchir Mikrochir Plast Chir. 2003 Jul

Weiss M, Baumeister RG, Hahn K. Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Germany. mayo.weiss@nuk.med.uni-muenchen.de

Key words Lymphoscintigraphy - lymphedema - lymph vessel transplantation

Autologous lymph vessel transplantation significantly improves the lymph drainage in patients with primary and secondary lymphedema. The aim of the present study was to prove whether scintigraphic long-term follow-up could demonstrate the function of autologous lymph vessels and the persisting success of this microsurgical technique respectively. In this study, visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients comparing a preoperative baseline study with postoperative follow-up investigations once a year for a period of seven years. The reason for microsurgical lymph vessel transplantation was a primary (n = 4) or a secondary (n = 16) lymphedema. In 12 cases the transplantation site was at the upper extremity, in eight cases at the lower limb. In 17/20 patients lymphatic function significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvement of lymph drainage and decrease of a numeric transport index. In 5/20 cases the vessel graft could be visualized directly. In these patients with scintigraphic visualization of the vessel graft, the transport index decreased to a significantly greater extent compared to the preoperative baseline study. 3/20 patients did not benefit from microsurgical treatment. Lymphoscintigraphy has shown to be an easy, reliable and readily available technique to assess lymphatic function on the long run. Scintigraphic visualization of the vessel graft showed a significantly better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding lymph drainage.

ThiemeConnect

Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study

Eur J Nucl Med Mol Imaging. 2003 Feb

Weiss M, Baumeister RG, Hahn K. Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, 80335 Munich, Germany. mayo.weiss@nuk.med.uni-muenchen.de

Keywords Lympohedema, Scintigraphy, Transplantation, Lymph drainage

The purpose of this study was to monitor the functional outcome of microsurgical intervention on lymph drainage by means of non-invasive, readily available lymphoscintigraphy. Eight patients with primary or secondary lymphoedema of the lower limb were investigated before and for 8 years after autologous lymph vessel transplantation. For scintigraphy, technetium-99m labelled nanocolloid was subcutaneously injected into the first interdigital space of the affected limb. Sequential images were acquired up to 6 h p.i.; for semiquantitative evaluation a numerical transport index was established by assigning scores of up to 9 on each of five criteria: lymphatic transport kinetics, distribution pattern of the radiopharmaceutical, time to appearance of lymph nodes, visualisation of lymph nodes and visualisation of lymph vessels/grafts. Ti values <10 were considered normal. In all eight patients, lymphatic function significantly (P</=0.01) improved after microsurgical treatment. Permanent function of vessel grafts was indicated by persistently low Ti values during the entire observation period, impressively demonstrating the success of this complex microsurgical technique. Patients with scintigraphic visualisation of the vessel graft (n=2/ showed a substantially better postoperative outcome than those without visualisation of the vessel graft. The findings indicate that lymph vessel transplantation significantly improves lymph drainage in patients with primary or secondary lymphoedema of the lower limb. Thus, lymphoscintigraphy is helpful not only in planning microsurgical treatment but also in monitoring the postoperative outcome.

SpringerLink

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lymph_vessel_transplant.txt · Last modified: 2013/01/05 07:33 by Pat O'Connor