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J Reconstr Microsurg 2023 Sep 26. Epub 2023 Sep 26.

Plastic Surgery, MedStar Washington Hospital Center, Washington, United States.

Background: Breast cancer-related lymphedema is the most common cause of lymphedema in the United States and occurs in up to 50% of individuals receiving axillary lymph node dissection (ALND). Lymphovenous bypass (LVB) at the time of ALND may prevent lymphedema, but long-term results and anastomotic patency are unclear. This study evaluates the feasibility and outcomes of performing immediate lymphatic reconstruction via coupler-assisted bypass (CAB). Read More

J Reconstr Microsurg 2023 Sep 26. Epub 2023 Sep 26.

Department of Surgery, Division of Plastic Surgery, University of Maryland Medical Center, Baltimore, United States.

Background: Recent advancements in supermicrosurgery and promising preliminary outcomes have led to a surge in physiologic lymphedema surgery. This study is the first to evaluate lymphedema surgical education among United States plastic surgery residency programs, along with the background and experience of plastic surgeons subspecializing in the field.

Methods: Cross-sectional evaluation of 103 accredited United States plastic surgery residency programs was performed in January 2023. Read More

J Reconstr Microsurg 2023 Sep 26. Epub 2023 Sep 26.

Department of Surgery, Brigham and Women's Hospital, Boston, United States.

Background: Prophylactic lymphatic bypass or LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) is increasingly offered to prevent lymphedema following breast cancer treatment, which develops in up to 47% of patients. Previous studies focused on intraoperative and postoperative lymphedema risk factors, which are often unknown preoperatively when the decision to perform LYMPHA is made. This study aims to identify preoperative lymphedema risk factors in the high-risk inflammatory breast cancer (IBC) population. Read More

Acta Oncol 2023 Aug 26;62(8):969-976. Epub 2023 Sep 26.

Breast Surgery Department, European Institute of Oncology IRCCS (IEO), Milan, Italy.

Purpose: Axillary Web Syndrome (AWS) is a common sequela after surgical axillary lymph node dissection (ALND) often manifesting with reduced range of motion (ROM) of the limb, which requires rehabilitation. Notwithstanding, a standardized rehabilitation protocol is currently lacking in clinical practice. Our primary objective was therefore to evaluate the effectiveness of the use of a snapping manual maneuver (SMM, used in our clinical practice) to increase ROM during abduction (ABD) when compared with a standardized stretching exercise (SSE) protocol. Read More

Int J Gynecol Cancer 2023 Sep 24. Epub 2023 Sep 24.

Gynecologic Oncology and Minimally Invasive Gynecologic Surgery Unit (Departament of Obstetrics and Gynecology), Hospital Universitario 12 de Octubre, Madrid, Spain

Background: Advances in the treatment of gynecological cancers have led to increased survival in patients with gynecological cancers. Nevertheless, patients may still experience prevalent long term consequences, including lower limb lymphedema, depression, anxiety, sexual dysfunction, malnutrition, and sarcopenia, that negatively impact their quality of life.

Primary Objective: To assess the impact on self-perceived quality of life of systematic screening and early treatment of lower limb lymphedema, anxiety and depression, sexual dysfunction, and sarcopenia and malnutrition compared with standard practice. Read More

Integr Cancer Ther 2023 ;22:15347354231198089

Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.

Cancer treatment remains a significant challenge for the medical community, and improved therapies are necessary to treat cancer and its associated complications. Current anticancer therapies often have significant side effects, underscoring the need for new treatment options. Moxibustion is a representative external therapy used in traditional Chinese medicine. Read More

Plast Reconstr Surg Glob Open 2023 Aug 22;11(8):e5219. Epub 2023 Aug 22.

Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Louis University School of Medicine, St. Louis, Mo.

Vascularized lymph node transfer (VLNT) is a surgical option to improve physiologic lymphatic drainage. This technique transfers healthy vascularized lymphatic tissue from various available donor sites to the existing lymphatics of the affected area. Here, we present a successful case halting the size progression and reversing lymphedema symptoms in a patient treated with vascularized omental lymph node transfer. Read More

Microsurgery 2023 Sep 24. Epub 2023 Sep 24.

Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.

Background: Soft tissue sarcomas are a subtle category of tumors that often require an extensive surgical resection for definitive treatment. This kind of intervention inevitably leads to large tissue damage and, when regions with rich lymphatic network are involved, postoperative complications such as lymphocele or lymphedema are quite common. In this report we present our experience with the combination of lymphatic procedures with perforator flaps for defects reconstruction and lymphatic complications preventions after sarcoma resection throughout the body. Read More

Clin J Gastroenterol 2023 Sep 22. Epub 2023 Sep 22.

Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.

A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Read More

Lymphat Res Biol 2023 Sep 20. Epub 2023 Sep 20.

Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA.

A recently completed clinical trial compared a novel nonpneumatic compression device (NPCD) with a traditional advanced pneumatic compression device (APCD) for the treatment of breast cancer-related lymphedema (BCRL); the study revealed that the NPCD produced superior clinical and quality-of-life (QOL) outcomes. In this subanalysis, we sought to examine these results within the subset of trial subjects aged ≥65 years. A randomized crossover head-to-head trial was conducted to compare the NPCD with a commercially available APCD. Read More

Gland Surg 2023 Jul 26;12(7):875-883. Epub 2023 Jun 26.

Department of Surgery, Dandenong Hospital, Monash University, Dandenong, Victoria, Australia.

Background: Vascularized lymph node transfer (VLNT) is an effective microsurgical method for the treatment of lymphedema. Knowledge of lymph node quantity and regional anatomy of donor sites are essential for surgery optimization. The aim of the study was to quantify the level I lymph nodes of the neck (submental and submandibular lymph nodes), describe the regional anatomy and review the current literature. Read More

Ann Surg Oncol 2023 Sep 19. Epub 2023 Sep 19.

Division of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China.

Background: Identification of risk factors facilitates the prevention of breast cancer-related lymphedema (BCRL). Several published systematic reviews have already addressed the risk factors for BCRL. This study aimed to systematically identify potential risk factors for BCRL and evaluate the quality of evidence. Read More

J Cancer Res Clin Oncol 2023 Sep 15. Epub 2023 Sep 15.

The Quzhou Affiliated Hospital of Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China.

Background: Breast cancer-related lymphedema (BCRL) may benefit from acupuncture as a therapeutic. However, the findings of systematic reviews (SRs) and meta-analyses (MAs) are inconsistent and their quality needs to be evaluated critically. We aimed to provide an overview of the methodological quality, risk of bias, quality of reporting, and quality of evidence for SRs/MAs of acupuncture for BCRL. Read More

Clin Hemorheol Microcirc 2023 Sep 9. Epub 2023 Sep 9.

Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.

Background: The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience "staining failure". In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. Read More

Surg Oncol Clin N Am 2023 Oct 25;32(4):705-724. Epub 2023 Jun 25.

Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA. Electronic address:

In the setting where breast cancer-related lymphedema (BCRL) remains a feared and common complication of breast cancer, here we review important factors for the development, diagnosis, prevention, and treatment of BCRL. We find that race/ethnicity affect BCRL development risk, that future studies should focus on understanding the biological reasons behind the increased susceptibility of certain racial minorities to BCRL, that surveillance, early detection, exercise programs, and arm compression can reduce the risk of BCRL, and that surgical techniques to preserve and restore lymphatic drainage being evaluated in randomized trials may become transformative in reducing BCRL risk for high-risk patients. Read More

J Vasc Surg Venous Lymphat Disord 2023 Sep 13. Epub 2023 Sep 13.

The RANE Center for Venous & Lymphatic Diseases, St. Dominic Hospital, Jackson, MS.

Objective: Phlebolymphedema has been noted to be one of the most common causes for lymphedema in the lower extremity in western societies. While complex decongestive therapy (CDT) represents the mainstay of treatment for lymphedema, its role in phlebolymphedema (PLE) arising from chronic iliofemoral venous obstruction (CIVO) merits further exploration. The authors evaluated this through use of a protocol of CDT first for limbs with CEAP clinical class 3 (C3) disease and stent correction of obstruction first for those with more advanced CEAP clinical class (C4-6) disease. Read More

Quant Imaging Med Surg 2023 Sep 8;13(9):5945-5957. Epub 2023 Aug 8.

Department of Orthopedics, Micro & Hand Surgery, Xiangya Hospital, Central South University, Changsha, China.

Background: The recent increase in the number of patients with lower extremities lymphedema and the development of microsurgery techniques have led to a rise in lymphedema treatment. Vascularized omental lymph node transfer (VOLT), an emerging treatment modality for extremity lymphedema, has shown its unique advantages in reconstructing lymphatic circulation and absorbing exudated lymphatic fluid. Patients who underwent radical tumor resection with/without radiation therapy treatment often present with impairment or degeneration of the inguinal lymph nodes. Read More

BMC Public Health 2023 Sep 14;23(1):1784. Epub 2023 Sep 14.

Department of Medical Microbiology, Centre for Vector-Borne Diseases Research, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana.

Background: Neglected tropical diseases (NTDs) are a major public health burden which mainly affects poor populations living in tropical environments and hard-to-reach areas. The study sought to examine coverage of preventive efforts, and case surveillance for NTDs in hard-to-reach communities in Ghana.

Methods: The study investigated treatment efforts for lymphatic filariasis (LF), and onchocerciasis and schistosomiasis/soil transmitted helminths (SCH/STH) at household level, in difficult-to-access communities in Ghana. Read More

J Vasc Surg Venous Lymphat Disord 2023 Sep 12. Epub 2023 Sep 12.

Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical University, 317000, Taizhou, China; Enze Hospital, Taizhou Enze Medical Center (Group), 317000, Taizhou, China. Electronic address:

Background: Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. This surgical procedure anastomosing the superficial lymphatic vessels to nearby veins to establish lymphatic-venous pathways. One of the most common challenges encountered by lymphatic surgeons while carrying out a lymphaticovenous anastomosis is a mismatch in sizes of the vein and lymphatic vessels as well as effectiveness limited by technical constraints. Read More

JAMA Netw Open 2023 Sep 5;6(9):e2333933. Epub 2023 Sep 5.

Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston.

Importance: Patients should have an active role in decisions about pursuing or forgoing specific therapies in treatment de-escalation trials.

Objective: To evaluate longitudinal patient-reported outcomes (PROs) encompassing decisional comfort and health-related quality of life (HRQOL) among patients who elected to enroll in a clinical trial evaluating radiotherapy alone, without breast surgery, for invasive breast cancers with exceptional response to neoadjuvant systemic therapy (NST).

Design, Setting, And Participants: Prospective, single-group, phase 2 clinical trial at 7 US medical centers. Read More

J Minim Access Surg 2023 Jul 5. Epub 2023 Jul 5.

Department of Obstetrics and Gynecology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China, India.

Introduction: Laparoendoscopic single-site inguinal lymphadenectomy (LESS-IL), a minimally invasive technique, has been reported in patients with vulvar or vaginal cancer regarding its safety and feasibility. However, the long-term outcomes, especially oncologic outcomes, are still lacking. We aimed to evaluate the long-term outcomes of LESS-IL to confirm its safety further. Read More

Int J Gynecol Cancer 2023 Sep 12. Epub 2023 Sep 12.

Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil

Objectives: To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer.

Methods: A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Read More

JCI Insight 2023 Sep 12. Epub 2023 Sep 12.

Molecular and Clinical Sciences Institute, St. George's University of London, London, United Kingdom.

Superficial erythematous cutaneous vascular malformations are assumed to be blood vascular in origin, but cutaneous lymphatic malformations can contain blood and appear red. Management may be different and so an accurate diagnosis is important. Cutaneous malformations were investigated through 2D-histology and 3D-whole-mount-histology. Read More

Sci Rep 2023 Sep 11;13(1):14966. Epub 2023 Sep 11.

Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.

Despite the tireless efforts of many researchers in lymphatic research, indocyanine green (ICG) solution conditions suitable for lymphatic circulation tests have not been perfectly established yet. We aimed to investigate the optimal in vivo conditions of ICG solution to avoid photobleaching and quenching effects, which may affect the accuracy of lymphatic circulation evaluation. After ICG fluorescence intensity (or ICG intensity) was assessed under different in vitro conditions, the image quality of brachial lymph nodes (LNs) and collecting lymphatic vessels (LVs) in eight rats was investigated. Read More

J Vasc Surg Venous Lymphat Disord 2023 Sep 9. Epub 2023 Sep 9.

Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa; Bruce and Ruth Rappaport Faculty of Medicine, Technion. Electronic address:

Objective: Lymphedema is a chronic condition caused by impaired lymphatic fluid drainage, resulting in progressive edema. The current mainstay of lymphedema therapy consists of conservative therapy and surgical therapy. In this systematic review, we investigated the novel role of biomaterials in clinical lymphedema therapy and assessed their objective outcomes as well as the complication rate associated with their use. Read More

Plast Reconstr Surg Glob Open 2023 Sep 7;11(9):e5237. Epub 2023 Sep 7.

From the Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: This study aimed to discuss several surgical approaches for advanced-stage breast cancer-related lymphedema and compared their treatment outcomes.

Methods: The patients who underwent surgery with International Society of Lymphology stage III lymphedema were included in this study. The three surgical methods used here were (1) suction-assisted lipectomy with lymphovenous anastomosis, (2) autologous breast reconstruction with muscle-sparing transverse rectus abdominis muscle flap combined with inguinal lymph node transfer, and (3) vascularized lymph node transfer with free omental flap. Read More

Plast Reconstr Surg Glob Open 2023 Sep 7;11(9):e5243. Epub 2023 Sep 7.

From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

Background: Lymphedema is an intractable disease for which there is currently no established curative therapy. A reliable and long-lasting lymphedema model is essential for development of better treatments. In this study, we aimed to establish a simple, reproducible and long-lasting mouse model of lymphedema. Read More

Signal Transduct Target Ther 2023 Sep 11;8(1):342. Epub 2023 Sep 11.

State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, 100084, China.

Intraluminal lymphatic valves (LVs) and lymphovenous valves (LVVs) are critical to ensure the unidirectional flow of lymphatic fluid. Morphological abnormalities in these valves always cause lymph or blood reflux, and result in lymphedema. However, the underlying molecular mechanism of valve development remains poorly understood. Read More

J Plast Reconstr Aesthet Surg 2023 Aug 21;86:35-47. Epub 2023 Aug 21.

Division of Plastic Surgery, University of Pennsylvania, United states. Electronic address:

Surgical care today is no longer evaluated only on clinical outcomes but also on holistic patient wellbeing. Patient-reported outcomes (PROs) are a representation of the patient's perspective on their results and wellbeing. The aim of this review is to establish PROs as the center of healthcare and plastic surgery, to delineate important PROs in plastic surgery practice and research, to discuss the future of PROs within our discipline, and to encourage surgeons to incorporate PROs into their practice. Read More