ABSTRACT
Lymphaticovenular anastomosis (LVA) using supermicrosurgical techniques is effective for treating and preventing progression of lymphedema. We analyzed the influence of pregnancy on LVA in five patients from a total 2179 LVA cases. Previous studies offer conflicting reports on whether pregnancy worsens pre-existing lymphedema. This is the first report on the influence of pregnancy on lower limb lymphedema previously treated by multisite LVA (mLVA). Five patients with primary (n=4) and secondary (n=1) lower leg lymphedema were analyzed for this study. Patient age ranged from 18 to 31 (average 22.6) years old with 4 right and 1 left extremities involved. Duration of symptoms ranged from one to 19 (average 7.4) years and the periods of compression therapy were from 1 to 19 years (6.6 years). Four patients had single pregnancies and one patient was multiparous with 3 pregnancies. Final follow-up ranged from 5.8 to 18 years (average 8.9 years) after the primary mLVA. All patients had normal pregnancy, birth, and no serious complications after surgeries. Following pregnancy three patients had complete functional recovery (limb volume reduction and no compression requirement), one with functional improvement (limb volume reduction but required compression), and one with no change in symptoms (not worse and continued need for compression). There were no occurrences of infection following pregnancy. Based on this case series, it is suggested that pregnancy does not worsen the pre-existing lymphedema in patients who had previously undergone mLVA. Further studies with larger number of patients are needed to confirm these results.
Subject(s)
Anastomosis, Surgical , Lower Extremity/pathology , Lymphedema/surgery , Microsurgery , Adult , Anastomosis, Surgical/methods , Female , Follow-Up Studies , Humans , Lower Extremity/surgery , Lymphatic Vessels/surgery , Lymphedema/diagnosis , Lymphedema/etiology , Microsurgery/methods , Pregnancy , Pregnancy Complications , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Intraneural ganglion cysts that occur within the common peroneal nerve are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presents with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to the flexor hallucis longus to a motor branch of the anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, and no evidence of recurrence and was able to weight bare without the need of orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
Les kystes intraneuraux de ganglions qui se forment sur le péronier proximal sont une rare cause de pied tombant. La norme actuelle du traitement de ce type de kyste sur le péronier proximal comprend 1) la décompression du kyste et 2) la ligature de la ramification du nerf articulaire pour éviter une récurrence. Le transfert des nerfs est une stratégie limitée dans le temps pour récupérer la dorsiflexion de la cheville en cas de paralysie importante du péronier. Cependant, cette modalité n'a pas été utilisée pour traiter des kystes intraneuraux du ganglion touchant le nerf du péronier proximal. Les auteurs présentent le cas d'une paralysie du péronier proximal causée par un kyste intraneural de ganglion chez une femme de 74 ans. La patiente a consulté parce qu'elle ressentait une douleur dans le péronier proximal droit et avait un pied tombant depuis cinq mois. Elle a subi une décompression du kyste, une ligature de la ramification du nerf articulaire et le transfert du nerf de la ramification motrice du long fléchisseur de l'hallux à une ramification motrice du muscle du tibia antérieur. Au dernier suivi, elle présentait une récupération complète (M4+) de la dorsiflexion de la cheville, ne souffrait plus d'aucune douleur et n'avait aucune trace de récurrence. Elle pouvait supporter son poids sans orthèse. Compte tenu de la morbidité minime au site du donneur et de la récupération de la dorsiflexion de la cheville, le présent rapport fait ressortir l'importance d'envisager le transfert précoce des nerfs en cas de neuropathie importante du péronier causée par un kyste intraneural de ganglion.
