Lymph node grafting in the treatment of upper limb lymphoedema: a clinical trial.

BACKGROUND: Microvascular lymph node transfer has been shown to improve the severity of lymphoedema. However, microvascular surgery is not suitable for all patients. Simple lymph node grafting does not require general anaesthetic or significant surgical resources and is a technique that has been tested in animal models only until this point. Our hypothesis is that the transplanted lymph nodes integrate into the lymphovascular system and function as a 'pump', directly pumping interstitial fluid back into the venous system. METHODS: We hypothesized that lymph node grafting would improve lymphoedema with a low risk of complications. The procedure was performed in a day surgery setting under local anaesthetic with sedation. Two lymph nodes were harvested from the groin and grafted into subcutaneous tissue on the volar aspect of the affected limb at supratrochlear and wrist levels. RESULTS: We found that nine of 10 patients reported a subjective and/or functional improvement in their lymphoedema, including an improvement in hand function and tissue feel. Truncal cone calculation volumes showed an overall decrease in affected limb volume of 89.7 mL (standard deviation = 136.5). Furthermore, follow-up lymphoscintigram imaging on one patient demonstrated viability and function of the implanted node. CONCLUSIONS: We conclude that this is a safe procedure and should be further investigated as an alternative to a microsurgical procedure as a treatment for upper limb lymphoedema. Further research with a larger sample size is needed to confirm the findings of this pilot study.

Suction dressings to secure a dermal substitute.

One of the problems with the dermal substitute Integra has been securing the material to the wound bed to prevent shearing and loss. Techniques to achieve stability include staples and elastic netting with an over layer of absorbent dressings that can be changed regularly. We report an effective technique using suction dressings to immobilise Integra. This technique led to firm application underlying tissue, and appeared to decrease fluid collection under the Integra. Earlier mobilisation and discharge from hospital were facilitated.

Limiting pericardial adhesions after coronary artery bypass: experimental study.

Retrosternal pericardial adhesion formation constitutes a major hazard during re-do coronary artery surgery. To determine whether an onlay parietal pleural flap over the internal thoracic artery bed would reduce pericardial adhesions after coronary artery grafting, 16 sheep underwent a median sternotomy and both internal thoracic arteries were harvested. On the randomly selected study side, a dissected pleural flap was used to cover the internal thoracic artery bed, the opposite side was left uncovered as a control. Half of the sheep were sacrificed at a median of 102 days (range, 93-109 days), the remainder at a median of 176 days (range, 165-183 days). Two independent observers blinded to the initial operation scored the degree of postoperative adhesions. There was a significant decrease in adhesion formation on the study side covered by the mobilized pleural flap, compared to the control side. There were no increases in pulmonary morbidity or sternotomy wound problems from raising the lateral pleural flap. This simple technique appears to be an effective method of preventing adhesion formation following coronary artery bypass grafting utilizing the internal thoracic artery.