Lymphaticovenous Anastomosis and Vascularized Lymph Node Transfer for the Treatment of Lymphedema-A Canadian Case Series.

Introduction: Lymphedema is a chronic and debilitating condition. This study aims to assess the efficacy and safety of lymphaticovenous anastomosis (LVA) and vascularized lymph node transfers (VLNT) for the treatment of patients suffering from lymphedema, mainly by comparing pre- and postoperative daily compression use, limb volumes, and occurrence of cellulitis. Methods: We performed a retrospective analysis of patients who were treated by a single surgeon for lymphedema with LVA and/or VLNT between March 2018 and February 2020. Eighteen limbs met the inclusion criteria. The severity of lymphatic dysfunction was assessed by indocyanine green lymphangiography. Patients with patent vessels were offered LVA, whereas those without were offered VLNT. Pre- and postoperative circumferential limb measurements, use of compression garments, and postoperative complications were compared. Results: Nine limbs underwent LVA, 8 underwent VLNT, and one both. The minimum follow-up was 12 months. Postoperatively, all but 3 patients (83%) were able to cease daily compression. When considering excess limb volumes, the average reduction was 58%. This reduction was achieved despite compression weaning. Forty-four percent of patients (8) reported episodes of recurrent cellulitis preoperatively, while postoperatively, only 3 of those patients (17%) experienced cellulitis, which was statistically significant (P = .018). No surgical complications occurred. Conclusions: Patients with lymphedema can benefit from LVA and VLNT surgery. An important effect of surgery is decreased dependence on daily compression garments to maintain a stable and reasonable limb volume. The reduction of limb circumference after 1 year was similar to LVA and VLNT. Episodes of cellulitis were significantly lower after the intervention.

Introduction : Le lymphœdème est une affection chronique et débilitante. La présente étude vise à évaluer l'efficacité et l'innocuité de l'anastomose lymphaticoveineuse (ALV) et des transferts des ganglions lymphatiques vascularisés (TGLV) pour le traitement des patients ayant un lymphœdème, surtout en comparant l'utilisation quotidienne des vêtements compressifs, le volume des membres et l'occurrence de cellulites avant et après l'opération. Méthodologie : Les chercheurs ont procédé à une analyse rétrospective des patients chez qui le même chirurgien a procédé à une ALV ou à un TGLV à cause d'un lymphœdème entre mars 2018 et février 2020. Dix-huit membres ont respecté les critères d'inclusion. Les chercheurs ont évalué la gravité du dysfonctionnement lymphatique par lymphangiographie au vert d'indocyanine. Les patients ayant des vaisseaux perméables se sont fait offrir une ALV, et les autres, un TGLV. Les chercheurs ont comparé les mesures du périmètre des membres et l'utilisation de vêtements compressifs avant et après l'opération, de même que les complications postopératoires. Résultats : Une ALV a été effectuée sur neuf membres, des TGLV, sur huit membres, et les deux interventions, sur un membre. La période de suivi minimale était de 12 mois. Après l'opération, tous les patients, sauf trois (83%), ont pu cesser la compression quotidienne. En moyenne, le volume excessif des membres a diminué de 58%. Les chercheurs ont obtenu cette réduction malgré le sevrage de la compression. Au total, 44% des patients (huit) ont signalé des récurrences de la cellulite avant l'opération, mais après l'opération, seulement trois d'entre eux (17%) en ont souffert, ce qui est statistiquement significatif. Aucune complication chirurgicale n'a été signalée. Conclusions : Les patients ayant un lymphœdème peuvent profiter d'une ALV ou d'un TGLV. Parmi ses effets importants, l'opération réduit la dépendance au port quotidien de vêtements compressifs afin que les membres conservent un volume stable et raisonnable. La réduction du paramètre des membres au bout d'un an était semblable après l'ALV et les TGLV. Les épisodes de cellulite étaient considérablement moins fréquents après l'intervention.

The Montréal Classification of urethral lengthening for phalloplasty in transmasculine patients-surgical techniques and urethral complications.

Introduction: Phalloplasties are one of the most performed genital surgeries in the treatment of gender dysphoria for transmasculine patients. Urethral lengthening is an essential component of phalloplasties. Few techniques have been described for the creation of this pars fixa urethra. The purpose of this article is to present the Montréal Classification for pars fixa urethral lengthening, to detail the surgical techniques and to report on clinical outcomes. Materials and methods: All patients undergoing phalloplasty from November 2016 to February 2019 were included in this study. Patient demographics, type of surgery and urological complications were recorded. Statistics were performed using student's T-test, Chi-squared test, Fisher's exact test and One-way ANOVA. Patients underwent either type 1, type 2, or type 3 urethral reconstruction. Results: Of the 84 total patients, 45 underwent type 1 lengthening, 28 type 2, and 11 type 3. Eighteen and 33 patients underwent single-stage and two stage anastomosis of the pars fixa to the pars pendulans neourethra, respectively. Thirty-three patients have not had any additional surgeries to date. Post-operative urological complications for immediate anastomosis and two-stage anastomosis were reported in 77.7% and 18.2% of patients, respectively. Conclusions: We propose a classification as well as a description of three types of urethral lengthening techniques. Over the last few years, we have shifted away from single-stage anastomosis and have adopted a two-stage anastomosis technique. Our experience allows us to classify urethral lengthening and to standardize care depending on patient characteristics, leading to excellent results.

Facial Gender-Affirming Surgery: Frontal Bossing Surgical Techniques, Outcomes and Safety.

BACKGROUND: Facial gender-affirming surgery (FGAS) is described as a set of surgical procedures done to feminize the soft tissue and the facial skeleton, allowing for transfeminine individuals to be recognizable as women to others. It is established in the literature that the most significant facial area for determination of gender is the forehead (Spiegel in Laryngoscope 121:250-261, 2011). This article describes the author's three main surgical techniques used in forehead feminization and reports on the results. METHODS: The type of surgery performed is based on the patient's anatomy. Type one FGAS consists of burring the anterior table of the frontal bone and is done when frontal bossing is very minimal. Type two FGAS includes burring and applying hydroxyapatite to contour the forehead and is done when frontal bossing is moderate. Type three surgery includes anterior table osteotomy, repositioning and fixation with a non-resorbable titanium plate and is performed for more severe frontal bossing. RESULTS: We present three techniques to feminize the forehead based on patient anatomy, modifying Ousterhout's methods with the use of hydroxyapatite and titanium plates. Complications were rare and consisted of hematoma (1%), chronic sinusitis (1%), cicatricial alopecia (3%), hardware palpability (5%) and delayed wound healing (6%). Ninety-five percent of patients reported being satisfied/highly satisfied with their cosmetic outcome. CONCLUSIONS: FGAS plays an important role in the treatment for gender dysphoria, offering transfeminine individuals an improvement in their self-esteem and quality of life. In our series of 100 cases, we demonstrate good esthetic outcomes with a low complication rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .