Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb
Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb
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DOI：
10.1002/micr.30247
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发表时间：
2017-11-01
期刊：
影响因子：
2.1
通讯作者：
Salgarello, Marzia
中科院分区：
文献类型：
--
作者：
Gentileschi, Stefano;Servillo, Maria;Salgarello, Marzia
前言：超显微外科淋巴静脉吻合术(LVA)可改善肢体淋巴水肿。我们描述了一种用于术前上肢淋巴标测的技术，当吲哚青绿(ICG)淋巴造影仅显示真皮回流(DB)而未检测到淋巴管时，患者和方法：16例因单侧UL淋巴水肿而接受LVA的患者，表现为“星尘”或“弥漫”DB模式。记录人口统计学、临床数据和肢体测量。采用LymQOL ARM问卷调查。患者平均年龄为58.8±13.1岁。女性15人，男性1人。应用ICG淋巴造影术对健康肢体进行淋巴解剖研究，并采用四步法对患肢进行了报告：在健肢上标记主要淋巴通路，测量通路与固定标志之间的七个平面之间的距离，在患肢上报告这些测量值，并与肿胀程度成正比，在该通路与小静脉的交叉处标记皮肤切口处，通过近红外线系统进行个体化。结果：每条肢体可找到3+/-0.73个切口点，每个切口点至少有一条淋巴管适合吻合。每例平均吻合3.38+/-0.62个吻合口。平均随访12.13+/-2.73个月。术后平均生活质量评分由术前的5.5分提高到7.9分(P
Introduction: Supermicrosurgical lymphatic-venous anastomosis (LVA) can improve limbs lymphedema. We describe a technique that we employ for preoperative lymphatic mapping of the upper limb (UL), when indocyanine green (ICG) lymphography shows only dermal backflow (DB) and no lymphatic vessel is detectable.Patients and methods: Sixteen patients undergoing LVA for unilateral UL lymphedema, showing "stardust" or "diffuse" DB pattern, were included. Demographic, clinical data, and limbs measurements were recorded. LymQoL arm questionnaire was administered. Mean age of patients was 58.8 +/- 13.1 years. Fifteen were females and 1 male. Lymphatic anatomy of the healthy limb was investigated by ICG lymphography and reported on the affected limb by a four steps technique: marking the main lymphatic pathway on the healthy limb, measuring of the distances at seven levels between the pathway and a line joining fixed landmarks, reporting these measurements on the affected limb with a correction proportional to the degree of swelling, marking skin incisions at the intersection of this pathway with venules, individuated by near infrared light system. Results were analyzed by postoperative questionnaire and changes of limb measurements.Results: For every limb, we could find 3 +/- 0.73 incision sites each containing at least one lymphatic vessel suitable for anastomosis. In every patient, we could perform 3.38 +/- 0.62 anastomoses. Mean follow-up was 12.13 +/- 2.73 months. After surgery, mean preoperative QoL score increased from 5.5 to 7.9 (P