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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3628_Библиотеки_им_академика_М_И_Перельмана
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Modern Surgical Management
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of Chronic Lymphedema
First Edition
Yves Harder, MD
Professor of Plastic Surgery
Head and Medical Director of the
Department of Plastic, Reconstructive,
and Aesthetic Surgery
Ospedale Regionale di Lugano
Ente Ospedaliero Cantonale (EOC)
Lugano, Switzerland;
Faculty of Biomedical Sciences
Università della Svizzera Italiana (USI)
Lugano, Switzerland
Katrin Seidenstücker, MD
Specialist in Plastic and
Aesthetic Surgery
Head of the Department of Plastic and
Aesthetic Surgery
Sana Hospital Benrath
Düsseldorf, Germany
Christoph Hirche, MD, FACS
Professor of Plastic Surgery
Head of the Department of Plastic
Surgery, Hand Surgery, and
Reconstructive Microsurgery
Hand Trauma and Replantation Center
BG Klinik Frankfurt am Main gGmbh
Frankfurt am Main, Germany
Moustapha Hamdi, MD
Professor of Plastic Surgery
Head of the Department of Plastic Surgery
and Founder of the Lymph Clinic
Brussels University Hospital
Brussels, Belgium;
Head of the UZ Brussel-Chirec
Joint-Network in Plastic Surgery
Brussels, Belgium
320 images
Thieme
Stuttgart • New York • Delhi • Rio de Janeiro
Library of Congress Cataloging-in-Publication Data is available
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from the publisher.
Important note: Medicine is an ever-changing science undergoing
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Cover design: © Thieme
Cover image source: the cover image was composed by Thieme
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Printed in Germany by Beltz Grafische Betriebe GmbH 5 4 3 2 1
DOI: 10.1055/b000000221
ISBN: 978-3-13-241428-0
Also available as an e-book:
eISBN (PDF): 978-3-13-241437-2
eISBN (epub): 978-3-13-258238-5
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow
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Contents
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Acknowledgements ........................................................xv
Foreword ................................................................. xvi
Preface ...................................................................xviii
Personal Prefaces ...........................................................xx
List of Abbreviations .......................................................xxiii
Contributors ..............................................................xxiv
Section I: Lymphology and Clinical Presentation
Edited by Yves Harder and Katrin Seidenstücker
1 Lymphatic System...................................................................... 3
1.1 Embryology of the Lymphatic
System
Florian Früh, Patrick A. Will, and
Epameinondas Gousopoulos
1.2 Anatomy of the Lymphatic System
Hiroo Suami
1.3 Physiology of the Lymphatic System
Florian Früh, Patrick A. Will, and
Epameinondas Gousopoulos
1.3.1 The Lymphatic System to Transport Lymph
Fluid (Circulating System) . . . . . . . . . . . . . . 8
.............................. 3
.... 4
.... 7
1.3.2 The Lymphatic System and Its
Immunological Function . . . . . . . . . . . . . . . 9
1.4 Lymphangiogenesis .................. 11
Patrick A. Will
1.4.1 Potential Therapeutic Approaches and
FuturePerspectives.................... 12
References .......................... 12
2 Epidemiological, Clinical, and Pathophysiological Aspects ........................ 14
2.1 Etiology including Lymphatic
Malformations
Stephan Wagner and Jörg Wilting
2.2 Prevalence
Katja Kilian
2.3 Incidence
Katja Kilian
....................... 14
.......................... 15
............................ 16
2.4 Pathophysiology
Katja Kilian
2.5 Stages and Classification of
Lymphedema
Stephan Wagner and Katja Kilian
References
..................... 17
........................ 19
.......................... 19
3 Lymphatic Filariasis .................................................................... 21
Gurusamy Manokaran and Leela Praveen Kumar
3.1 Prevalence
3.2 Pathophysiology ..................... 21
.......................... 21
3.2.1 Pathology............................ 22
3.3 Clinical Manifestations ............... 22
Contents
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3.3.1 Diagnosis ............................ 22
3.3.2 Clinical Classification of Filarial
Lymphedema......................... 23
3.4.3 Management of Stage III and IV. . . . . . . . . . 24
3.4.4 Management of Stage V, VI, and VII . . . . . . 24
3.5 Clinical Case ......................... 24
3.4 Management ........................ 23
3.6 Conclusions ......................... 24
3.4.1 Management of Filarial Lymphedema . . . . 23
3.4.2 Management of Stage I and II . . . . . . . . . . . 23
References .......................... 25
Section II: Diagnostic Evaluation
Edited by Christoph Hirche
4 Diagnostics and Stage-Dependent Preoperative Evaluation ....................... 29
4.1 Medical History ...................... 29
Tomke Cordts
4.2 Clinical Examination
.................. 29
Tomke Cordts
4.2.1 TissueResistance...................... 30
4.3 Nonapparative Volume
Measurement
........................ 30
Tomke Cordts
4.3.1 Circumference........................ 31
4.3.2 WaterDisplacement................... 32
4.4 Ultrasound Imaging .................. 33
Giuseppe Visconti, Alessendro Bianchi,
Marzia Salgarello, and Akitatsu Hayashi
4.4.1 Advantages of Technology in
Preoperative Planning of Lymphovenous
Anastomoses......................... 35
4.4.2 Advantages of Ultrasound in Preoperative
Planning of Vascularized Lymph Node
Transfer.............................. 36
4.5 Scintigraphic Lymphangiography ..... 36
Pierre Bourgeois
4.6 Indocyanine Green
Near-Infrared Imaging
................ 38
Emre Gazyakan
4.6.1 IndocyanineGreen.................... 38
4.6.2 Lymphangiography.................... 39
4.6.3 Reversed Lymphatic Mapping . . . . . . . . . . . 41
4.6.4 Conclusions .......................... 42
4.7 Magnetic Resonance Imaging ......... 43
Carola Brussaard
4.7.1 Conventional Magnetic Resonance
Imaging: Detection of Free
Movable Fluid, Fat Deposition as Stage
Parameter, and Volumetry . . . . . . . . . . . . . . 43
4.7.2 Magnetic Resonance Imaging of
LymphaticVessels..................... 44
4.7.3 TipsandTricks........................ 48
4.8 Functional Magnetic Resonance
Lymphangiography
.................. 48
Carola Brussaard, Hans Schild, and Claus
Christian Pieper
4.8.1 Technique............................ 48
4.8.2 Diagnosis of Peripheral Lymphatic
Leakage.............................. 50
4.9 Pearls and Pitfalls .................... 51
Tomke Cordts
References
.......................... 52
vi
Section III: Modern Management of Chronic Lymphedema
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Edited by Yves Harder
5 Establishment of an Interprofessional and Multidisciplinary Lymphedema
Network
Holger Engel
................................................................................. 57
Contents
5.1 Presentation of the Concept
.......... 57
5.6 Expert Group/Lymphedema Board and
Patient Advocacy
.................... 58
5.2 Goals ................................ 57
5.7 Evidence-Based Medical Care ......... 59
5.3 Organizational Structure and Involved
Personnel
........................... 58
5.8 Future of Lymphedema Networks and
Data-Driven Medicine
................ 59
5.4 Funding ............................. 58
5.9 Pearls and Pitfalls .................... 59
5.5 Marketing ........................... 58
References .......................... 59
Section IV: Non-Surgical Treatment and Techniques
Edited by Christoph Hirche
6 Integrative, Multiprofessional Conservative Treatment............................ 63
Joachim E. Zuther
6.1 Background
6.2 Complete Decongestive Therapy ...... 63
6.2.1 Goals of Complete Decongestive
Therapy.............................. 63
6.2.2 Components of Complete Decongestive
Therapy.............................. 64
6.3 The Two-Phase Approach in
Lymphedema Management
6.3.1 IntensivePhase....................... 79
6.3.2 Self-Management Phase. . . . . . . . . . . . . . . . 81
6.3.3 PatientEducation ..................... 81
6.4 Limitations of Complete Decongestive
Therapy in Lymphedema
Management
6.5 Additional Treatment Modalities ...... 83
......................... 63
........... 79
........................ 81
6.5.1 Sequential Intermittent Pneumatic
Compression ......................... 83
6.5.2 ElasticTaping......................... 84
6.6 Documentation and Screening
Modalities for Conservative
Lymphedema Management
........... 85
6.7 Role of Weight Management,
Nutrition, and Supplements
.......... 86
6.8 Outpatient versus Inpatient
Treatment
........................... 86
6.9 Wound Management in Lymphedema
Patients
6.9.1 Types of Lymphedema-Related Wounds . . . 86
6.9.2 Modification of Lymphedema Bandaging
in the Presence of Wounds . . . . . . . . . . . . . 88
............................. 86
References .......................... 88
Contents
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Section V: Surgical Treatment and Techniques
Edited by Yves Harder
7 Basic Principles of Surgical Treatment and Accompanying Complete
Decongestive Therapy
................................................................. 91
7.1 Lymphatic Surgery ................... 91
Jaume Masià and Cristhian D. Pomata
7.1.1 Introduction.......................... 91
7.1.2 Pathophysiological Aspects and Clinical
Considerations........................ 91
7.1.3 Diagnostic Imaging Techniques. . . . . . . . . . 92
7.1.4 Surgical Procedures. . . . . . . . . . . . . . . . . . . . 92
7.1.5 Conclusions .......................... 93
7.2.2 Background .......................... 94
7.2.3 Evidence-Based Practice for Perioperative
Complete Decongestive Therapy. . . . . . . . . 96
7.2.4 Best Practices—the Expert’s Opinion . . . . . 99
7.2.5 Discussion............................ 100
7.2.6 Conclusions .......................... 102
References .......................... 102
7.2 Complete Decongestive Therapy in the
Pre- and Postoperative Setting
........ 93
Nele Adriaenssens, Ellen Vandyck, and
Sarah Harnie
7.2.1 Introduction.......................... 93
Section VI: Lymphoreconstructive Procedures
Edited by Yves Harder, Christoph Hirche, Katrin Seidenstücker, and Moustapha Hamdi
8 Lymphovenous Anastomosis.......................................................... 107
Johnson Chia-Shen Yang and Christoph Hirche
8.1 Introduction
8.1.1 Definition............................ 107
8.1.2 Key Concepts of Supermicrosurgical
Lymphovenous Anastomosis . . . . . . . . . . . . 108
8.2 Indications and Contraindications for
Lymphovenous Anastomosis
......................... 107
.......... 110
8.3.4 Timing for the Indocyanine Green
Injection for the Identification of
Functional Lymphatic Vessels . . . . . . . . . . . 112
8.3.5 Identifying Reflux-Free Veins with a Vein
Finder(VeinViewer)................... 112
8.3.6 Other Imaging Studies for Preoperative
Evaluation and Planning of Lymphovenous
Anastomosis.......................... 113
8.2.1 Current Consensus Regarding Surgical
Treatment for Lymphedema with
Lymphovenous Anastomosis . . . . . . . . . . . . 110
8.2.2 Indications........................... 111
8.2.3 Contraindications ..................... 111
8.3 Preoperative Evaluation and Planning . . 111
8.3.1 MedicalHistory....................... 111
8.3.2 Preoperative Evaluation for
Lymphovenous Anastomosis . . . . . . . . . . . . 112
8.3.3 Identifying Functional Lymphatic
Vessels .............................. 112
viii
8.4 Surgical Setting and Technique ....... 113
8.4.1 Anesthesia: Local, Regional, or General . . . 113
8.4.2 Intraoperative Position. . . . . . . . . . . . . . . . . 114
8.4.3 Technique of Supermicrosurgical
Lymphovenous Anastomosis . . . . . . . . . . . . 115
8.4.4 Which Suture Technique Is Best Suited for
Supermicrosurgery?................... 116
8.4.5 Documentation....................... 117
8.4.6 Dressing............................. 117
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