The Addition of Hyaluronidase to Tumescent Local Anesthesia Supports Lymphological Liposculpture of Secondary Lymphedema.
The Addition of Hyaluronidase to Tumescent Local Anesthesia Supports Lymphological Liposculpture of Secondary Lymphedema.
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DOI：
10.1097/gox.0000000000003995
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Hettenhausen C
中科院分区：
文献类型：
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作者：
Cornely ME;Hettenhausen C
蛋白聚糖（PG）是调节水体流动所必需的。从淋巴停滞的第1阶段开始，存在间质PG的积累，其调节增加的液体。随着疾病的进展，形成的PG多于降解的PG，导致增殖，并且实体组织的周长和体积增加。由于交联的PG而非常坚硬的这种皮下组织的去除在水肿手术中是一个特别的挑战。透明质酸酶对这些PG结构具有溶解作用，并且在皮下浸润后，降低细胞外基质的粘度，促进溶液扩散和渗透到周围组织中。通过在我们的血管保留手术方案（淋巴脂肪雕刻）中使用透明质酸酶，即使在15年后，我们也没有观察到任何水肿复发。
Proteoglycans (PG) are essential for regulating water flow in the interstitium. From stage 1 of lymphostasis, there is an accumulation of interstitial PG, which regulate the increasing fluids. As the disease progresses, more PG are formed than degraded, resulting in proliferation, and increases in circumference and volume of solid tissue. The removal of this subcutaneous tissue, which is very rigid due to cross-linked PG, is a particular challenge in lymphedema surgery. Hyaluronidase has a lytic effect on these PG structures and, after subcutaneous infiltration, reduces the viscosity of the extracellular matrix, promoting diffusion and penetration of solutions into the surrounding tissue. By using hyaluronidase in our vascular-sparing surgical protocol (lymphological liposculpture), we have not observed any lymphedema recurrences even after 15 years.