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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3783_Библиотеки_им_академика_М_И_Перельмана
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MarkV.Schaverien
JosephH.Dayan
Editors
Multimodal Management
ofUpper and Lower
Extremity Lymphedema
123
Multimodal Management of Upper and Lower
Extremity Lymphedema
Mark V. Schaverien • Joseph H. Dayan
https://t.me/medicina_free
Editors
Multimodal Management
of Upper and Lower Extremity
Lymphedema
Editors
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Mark V. Schaverien
Department of Plastic Surgery
The University of Texas MD Anderson
Cancer Center
Houston, TX, USA
Joseph H. Dayan
Division of Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, USA
ISBN 978-3-030-93038-7 ISBN 978-3-030-93039-4 (eBook)
https://doi.org/10.1007/978-3-030-93039-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
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Although our understanding of the pathogenesis of lymphedema and its treatment have traditionally languished behind that of rarer diseases, currently there is rapidly growing interest in
lymphedema paralleled by an increase in the number of experts treating and investigating it,
placing us at the dawn of tremendous advances for a condition that has been relatively neglected
in medicine. Advances in non-surgical and surgical treatments have ameliorated the functional
and psychosocial disability of lymphedema. The treatment of lymphedema has traditionally
resided with the lymphedema therapist alone; however, rapid advances in the last 5–10years
in imaging, surgical instruments, and surgical techniques have led to the development of modern surgical and supermicrosurgical procedures that work in concert with optimized conservative treatment to improve the magnitude and consistency of outcomes from lymphedema
surgery.
Recently, there has been growing interest in lymphedema due to an increase in the number
of centers with specialist teams assembled to treat the condition, supported by an increasing
evidence-base demonstrating the effectiveness of surgical techniques that continues to provide
higher-level supportive evidence through better conducted and controlled studies. In around a
quarter of patients with limb swelling, a diagnosis other than lymphedema accounts for their
condition, leading to improper or delayed treatment. Thus, there is an urgent healthcare need
for wider availability of, and greater access to, specialist centers with expertise in evaluation of
the patient presenting with limb swelling, and that offer the full complement of non-surgical
and surgical treatments for the condition.
There is a strong evidence base supporting the effectiveness of lymphedema surgical procedures in reducing symptoms, limb volume excess, extracellular uid, and episodes of cellulitis,
and in improving limb function and the patient’s quality of life. No single procedure is equally
effective in all patients, and it is imperative that the surgical team provides the full spectrum of
the modern surgical treatments available, complemented by skilled conservative therapy,
including lymphovenous bypass (LVB), vascularized lymph node transplantation (VLNT),
and suction-assisted lipectomy (SAL) debulking surgery with continuous compression therapy
(CCT), to maximize outcomes. Indocyanine green (ICG) lymphography has become an important and practical tool for aiding in decision-making between the available surgical options.
Many patients with breast cancer–related lymphedema (BCRL) have comorbid axillary contracture limiting range of motion, and lysis of axillary scar adhesions and orthotopic proximal
VLNT to the axilla is an important component of their lymphedema surgical treatment. In
patients with early obstructive lymphedema conned to the upper arm, axillary adhesiolysis
and orthotopic transplantation of groin lymph nodes as a composite with the deep inferior
epigastric artery perforator (DIEP) ap for postmastectomy breast reconstruction, or microsurgical omental lymphatic ap transfer, can provide signicant benet. In appropriately selected
patients with signicant broadipose soft tissue excess that affects function, who are continuously complaint with compression garments and have minimal pitting edema, SAL can achieve
tremendous improvements in quality of life and limb function with minimal morbidity.
In the developed world, lymphedema predominantly affects survivors of breast, gynecologic, or urologic cancers, for whom it may be their greatest survivorship burden. Caring for
lymphedema imposes a signicant time burden on patients and their carers, and leads to
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cumulative and cascading economic consequences from the costs of lymphedema management and compression garments, the treatment of infections, and the loss of work productivity.
Modern- day management of lymphedema recognizes the superior effectiveness of the multimodal multidisciplinary team approach in improving patient outcomes. This includes riskreduction strategies and prophylactic surgeries (immediate lymphatic reconstruction) to reduce
the risk of developing lymphedema, optimization of conservative therapy in established
lymphedema to reduce progression, and combined surgical approaches including physiological and debulking procedures, where appropriate, to maximize outcomes. These should be
delivered within lymphedema centers offering the highest standard of best practice multi-team
comprehensive care.
In this book – Multimodal Management of Upper and Lower Extremity Lymphedema–
world experts in the eld of lymphedema concisely and comprehensively detail all of these
non-surgical and surgical approaches. The chapters uniquely provide a step-by-step practical
multidisciplinary approach and framework for performing each aspect of the multimodal management of the lymphedema patient, as well as comprehensive instruction for those treating
such patients, accompanied by key video contributions from the authors. It also provides a
framework for collecting outcomes measures for these patients to improve the consistency of
outcomes data and allow for comparisons between the different treatments and across institutions internationally. In addition to the array of treatment options for this currently incurable
disease, new therapies that target inammation and brosis to prevent and treat lymphedema,
either primarily or in conjunction with surgical modalities, are reviewed – the outcomes of
translational research studies are eagerly awaited to more effectively treat patients and reduce
their morbidity.
Preface
Houston, TX, USA MarkV.Schaverien
New York, NY, USA JosephH.Dayan
Acknowledgments
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We owe the authors of chapters in this book an enormous debt of gratitude for their contributions to this landmark book on the multimodal management of upper and lower extremity
lymphedema that details the current state of lymphedema science, patient evaluation, and treatment. We especially want to acknowledge the lymphedema therapists, nurses, physicians, and
surgeons, who have dedicated their careers to tirelessly treating patients suffering with lymphedema to improve their quality of life.
We want to thank our project coordinators, Nishanthini Vetrivel and Sasirekka Nijanthan, at
Springer Nature, our project manager, ArulRonika Pathinathan, and our editor, Asja Rehse, at
Springer, who have provided invaluable support for this project from conception to completion– without them, this book would not have been possible. We also wish to thank the graphics team at Springer for their wonderful illustrations to accompany the chapters to communicate
key anatomical concepts.
Houston, TX, USA MarkV.Schaverien
New York, NY, USA JosephH.Dayan
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Contents
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1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mark V. Schaverien and Joseph H. Dayan
2 Anatomy of the Lymphatic System and Structural Changes
in Lymphedema of the Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Akira Shinaoka and Hiroo Suami
3 Pathophysiology and Molecular Research in Lymphedema . . . . . . . . . . . . . . . . . . 15
Elizabeth Kiwanuka and Babak Mehrara
4 Lymphedema Prospective Surveillance and Risk Reduction . . . . . . . . . . . . . . . . . 23
Nicole L. Stout and Jane M. Armer
5 Key Topic: Multimodal Evaluation of the Lymphedema Patient . . . . . . . . . . . . . . 29
Mark V. Schaverien and Joseph H. Dayan
6 Nonsurgical Management of the Lymphedema Patient . . . . . . . . . . . . . . . . . . . . . 39
Marc A. Miller, Mark V. Schaverien, and Dawn N. Chen
7 Key Topic: Patient Selection and Evidence-Based Algorithmic Approach
to Surgical Management of Lymphedema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Mark V. Schaverien and Joseph H. Dayan
8 Step-by-Step Instruction: Lymphaticovenular Anastomosis (LVA)
Assessment and Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Akitatsu Hayashi
9 Step-by-Step Instruction: Lymphaticovenular Anastomosis (LVA)
Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Takumi Yamamoto and Jose Ramon Rodriguez
10 Step-by-Step Instruction: Single Site Multiple Lymphatic-Venous
Anastomosis Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Corrado Cesare Campisi, Lidia Molinari, Pietro Giovanni di Summa,
and Corradino Campisi
11 Reverse Lymphatic Mapping for Vascularized Lymph Node Transplant . . . . . . . 83
Joseph H. Dayan
12 Key Topic: Vascularized Lymph Node Transplant and Recipient
Site Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Mark V. Schaverien and Joseph H. Dayan
13 Step-by-Step Instruction: Superficial Inguinal (Groin) Vascularized
Lymph Node Transplant Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Ketan M. Patel
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14 Step-by-Step Instruction: Combined Microvascular Breast
Reconstruction and Groin Vascularized Lymph Node Transplant
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Jaume Masia, Gemma Pons, and Cristhian Pomata
15 Step-by-Step Instruction: Submental Vascularized Lymph Node
Transplant Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Ming-Huei Cheng and Olivia Ho
16 Step-by-Step Instruction: Supraclavicular Vascularized Lymph
Node Transplant Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Rebecca M. Garza and David W. Chang
17 Step-by-Step Instruction: Lateral Thoracic Vascularized Lymph
Node Transplant Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Joseph H. Dayan
18 Step-by-Step Instruction: Omental Vascularized Lymph Node Transplant
Procedure: Laparoscopic and Open Harvest Techniques . . . . . . . . . . . . . . . . . . . . 129
Carrie K. Chu and Mark V. Schaverien
19 Step-by-Step Instruction: Jejunal Mesenteric Vascularized Lymph Node
Transplant Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Duane Wang and Roman Skoracki
Contents
20 Step-by-Step Instruction: Suction- Assisted Lipectomy Procedure
with Controlled Compression Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Håkan Brorson
21 Step-by-Step Instruction: Suction- Assisted Protein Lipectomy
Procedure Combined with Vascularized Lymph Node Transfer
and/or Lymphaticovenous Anastomosis Surgery as Part of an Integrated
Lymphedema Treatment System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Jay W. Granzow
22 Step-by-Step Instruction: Direct Excision Combined with
Lymphatic Microsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Kavan S. Johal and Hung-Chi Chen
23 Step-by-Step Instruction: Immediate Lymphatic Reconstruction
for Lymphedema Risk Reduction in Breast Cancer Management . . . . . . . . . . . . . 169
Melisa D. Granoff, Ryoko Hamaguchi, and Dhruv Singhal
24 Key Topic: Evidence-Based Outcomes of Lymphedema Microsurgery . . . . . . . . . 175
Mark V. Schaverien and Joseph H. Dayan
25 Key Topic: Evaluating Outcomes of Lymphedema Surgery . . . . . . . . . . . . . . . . . . 193
Mark V. Schaverien and Joseph H. Dayan
26 New and Emerging Therapies for Lymphedema: Part I . . . . . . . . . . . . . . . . . . . . . 199
Alex K. Wong and Anjali C. Raghuram
27 New and Emerging Therapies for Lymphedema: Part II . . . . . . . . . . . . . . . . . . . . 209
Robert C. Sibley and Stanley G. Rockson
28 Lymphatic Education and Research Network Centers of Excellence:
A Multidisciplinary Approach to Lymphatic Care . . . . . . . . . . . . . . . . . . . . . . . . . 215
Melisa D. Granoff, Rosie Friedman, Arin K. Greene, and Dhruv Singhal
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Contributors
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Jane M. Armer University of Missouri, Sinclair School of Nursing, Ellis Fischel Cancer
Center, Columbia, MO, USA
HåkanBrorson Lymphedema Center, Plastic and Reconstructive Surgery, Skåne University
Hospital, Malmö, Sweden
Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
CorradoCesareCampisi Plastic, Reconstructive and Aesthetic Surgery, Private Consultant,
Genoa, Italy
University of Catania, Genoa & Catania, Italy
Corradino Campisi General Surgery, Vascular Surgery and Emergency Surgery, Clinical
Lymphology, Lymphatic Surgery and Microsurgery, School of Medical Sciences and
Pharmaceutics, Department of Surgical Sciences and Integrated Diagnostics – DISC, University
of Genoa, Genoa, Italy
David W. Chang Department of Surgery, Section of Plastic and Reconstructive Surgery,
University of Chicago, Chicago, IL, USA
Dawn N. Chen MD Anderson Cancer Center – West Houston, Rehabilitation Services,
Houston, TX, USA
Hung-Chi Chen Department of Plastic Surgery, China Medical University Hospital,
Taichung, Taiwan
Ming-Huei Cheng Department of Plastic and Reconstructive Surgery, Mayo Clinic,
Jacksonville, FL, USA
Section of Plastic Surgery, The University of Michigan, Ann Arbor, Michigan, USA
CarrieK.Chu Department of Plastic Surgery, The University of Texas MD Anderson Cancer
Center, Houston, TX, USA
JosephH.Dayan Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, USA
PietroGiovannidiSumma Department of Plastic, Reconstructive and Hand Surgery, Centre
Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
RosieFriedman Boston Lymphatic Center, Division of Plastic and Reconstructive Surgery,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
RebeccaM.Garza Department of Surgery, Section of Plastic and Reconstructive Surgery,
University of Chicago, Chicago, IL, USA
MelisaD.Granoff Boston Lymphatic Center, Division of Plastic and Reconstructive Surgery,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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