Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases.

Introduction: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain. Methods: Each patient received 32-36 injections of 25 µg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function. Results: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient. Discussion: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema.

BACKGROUND: Conventional advice to reduce the risk of breast cancer-related lymphedema (BCLE) suggests avoidance of daily-living risks, and limited research has investigated these risks. OBJECTIVE: This study aimed to examine the occurrence, patterns, and effects of daily-living risks on BCLE. METHODS: A cross-sectional design was used to collect data from 567 patients at a metropolitan cancer center in the United States. The Lymphedema Risk-Reduction Behavior Checklist was used to assess the occurrence of 11 daily-living risks. Descriptive, regression, and factor analyses were performed. RESULTS: Significant odds of BCLE were associated with infection (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.95-3.42), cuts/scratches (OR 2.65, 95% CI 1.97-3.56), sunburn (OR 1.89, 95% CI 1.39-3.56), oil splash or steam burns (OR 2.08, 95% CI 1.53-3.83), and insect bites (OR 1.59, 95% CI 1.18-2.13). The daily-living risks were clustered into factors related to skin trauma and carrying objects. Skin trauma risk was significantly associated with BCLE (B = 0.539, z = 3.926, OR 1.714, 95% CI 1.312-2.250; p < 0.001). Having three, four, or five skin trauma risks significantly increased the odds of BCLE to 4.31, 5.14, and 6.94 times, respectively. The risk of carrying objects had no significant or incremental effects on BCLE. CONCLUSION: Complete avoidance of daily-living risks is challenging given 52.73% of patients incurred more than five daily-living risks. Our study findings underscore the importance of 'what to do' strategies to minimize infection and skin trauma.

Advantages of the intradermal lymphoscintigraphy.

Lymphoscintigraphy is a nuclear medicine procedure that uses a small quantity of radioactive particles for visualizing the lymphatic system. Traditionally, the radiotracer was injected subcutaneously, but the quality of lymphatic path imaging was scarce due to high background. Intradermal radiotracer injection is considered the modern-day intralymphatic injection. We propose rest/stress intradermal lymphoscintigraphy for the diagnosis, staging and surgical planning of lymphedema. Major and minor findings were described in primary and secondary lymphedema. Based on the in-depth information of the lymphatic pathways, physiotherapists and microsurgeons can obtain important functional information in patients' selection to treat with physical treatments and/or undergo microsurgery.

The effects of ACSM-based exercise on breast cancer-related lymphoedema: a systematic review and meta-analysis.

Background: Breast cancer-related lymphedema (BCRL) frequently occurs after axillary lymph node dissection and remains incurable even with lymphaticovenular anastomosis. Exercise interventions have emerged as a potential non-pharmacological management approach. However, standardized exercise recommendations tailored to BCRL patients are lacking. Purpose: This study evaluated the impact of high and low compliance exercise interventions, aligned with ACSM recommendations, on quality of life (QOL), shoulder range of motion (ROM), and arm volume in BCRL patients. It further aimed to determine the optimal exercise dosage, assessed via the FITT (frequency, intensity, time, type) principle, that maximizes health benefits for BCRL patients. Methods: Adhering to the PRISMA guidelines for systematic reviews and meta-analyses, we conducted a comprehensive literature search in various databases, including PubMed, Embase, Cochrane Library, and Web of Science, encompassing the period from the inception of these databases to December 2023. We extracted data on exercise form, frequency, intensity, duration, repetitions, and sets from the identified studies. Subsequently, a meta-analysis and review were conducted. The exercise interventions were evaluated based on ACSM recommendations and categorized as either high or low compliance with ACSM standards. Fixed or random effects models were employed to compare outcomes across study subgroups with comparable results. Additionally, funnel plot analyses, sensitivity analyses, and Egger's and Begg's tests were conducted to evaluate the potential for bias. Results: 15 studies encompassing 863 patients with BCRL were analyzed. Eleven studies exhibited high ACSM compliance, while four demonstrated low ACSM compliance. Regarding QOL, the overall standard mean difference (SMD) was 0.13 (95% CI: -1.07, 1.33). Specifically, the SMD for the high-adherence subgroup was 0.91 (95% CI: 0.33, 1.49; p = 0.002). For ROM, the overall SMD was 1.21 (95% CI: -0.19, 2.61). For arm volume, the overall SMD was -0.06 (95% CI: -0.22, 0.10). QOL results differed significantly in the high-adherence subgroup, whereas no significant effect on ROM or arm volume was observed. Conclusion: The study revealed significant QOL improvements in patients with high ACSM compliance, contrasted with those with low compliance. Conversely, no notable changes in ROM or arm volume were observed. Notably, the high adherence group tended to show better ROM during exercise and stable arm volume. Future research is needed to validate these findings.

Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection: A case report.

BACKGROUND: Lower extremity lymphedema is a common complication following treatment for gynecological malignancies. Its incidence rate can reach up to 70%, affecting ~20 million people worldwide. However, specialized treatment centers are scarce, and there is a lack of consensus on treatment approaches. Furthermore, there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations. Effective management of this condition remains a significant challenge for clinicians. CASE SUMMARY: A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer. Since August 2018, she experienced > 30 episodes of lymphangitis. Upon presentation, she exhibited bilateral leg swelling and deformation, with four large swellings in the posterior thigh that impeded movement, and pain in the limbs. Skin manifestations included lichenoid lesions and features of deep sclerosis. Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema. After 6 mo of complex decongestive therapy (CDT) and three lymphaticovenous anastomosis (LVA) treatments, the patient lost 49 kg in weight. She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb. The leg pain disappeared, her swelling significantly decreased, and she regained the ability to walk, cycle, and run normally. CONCLUSION: The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe, deformed stage III lymphedema.

Skin mechanical properties measured with skin elasticity measurement device in patients with lymphedema: Scoping review.

BACKGROUND: Skin conditions in patients with lymphedema have been identified according to changes in skin mechanical properties. The skin elasticity meter is a non-invasive tool for measuring the mechanical properties of the skin; however, its potential use in patients with lymphedema has received little attention. This review aimed to provide an overview of studies measuring the skin mechanical properties of patients with lymphedema using a skin elasticity meter. MATERIALS AND METHODS: Search terms and synonyms related to lymphedema and skin mechanical property measurement using a skin elasticity meter were identified, and electronic databases containing articles in English were searched. RESULTS: A total of 621 articles were retrieved, and four articles were analyzed after screening. Despite this research subject receiving increasing attention, no consensus has been reached regarding the best methods. CONCLUSION: Measurement methods are expected to be standardized in the future to elucidate the skin mechanical properties of patients with lymphedema.

Lymphedema self-management mobile application with nurse support for post breast cancer surgery survivors: description of the design process and prototype evaluation.

BACKGROUND: Self-management is the key to control breast cancer related lymphedema (BCRL). This study aimed to develop a mobile application with nurse support for lymphedema self-management and evaluate its usability from the patients' points of view. METHODS: This applied developmental study was conducted on 87 women in a lymphedema clinic, Shiraz, Iran, May-November 2023. The study included three phases: development, distribution of the application and usability evaluation. In the development phase, the researchers developed application using the Java programming language. In distribution phase, the application was installed on the participants' phones. For usability evaluation, 87 patients completed the user satisfaction questionnaire after three months access to the application. Data was analyzed using descriptive and analytical statistics using SPSS software 22. P-value less than 0.05 was considered significant. RESULTS: We designed a self-management application specific to BCRL that included ten unique modules mainly related to patient education, interaction with peers and nurse, self-management support, and settings. The application mean usability score was 7.72 ± 1.08. The usability dimensions of "screen" (8.06 ± 1.02) and "terminology and systems information" (7.29 ± 1.62) received the highest and lowest mean scores, respectively. CONCLUSION: The application has new features to meet more patients' needs compared to what other existing lymphedema self-management applications already have addressed. The findings showed that the participants rated the application usability at the "good" level that is similar to some previous studies. Considering the unique nature of the application and its favorable usability, we recommend its use for BCRL self-management.

Efficacy, safety of and adherence to adjustable compression wraps in the control phase of breast cancer-related lymphedema: A randomized controlled trial.

OBJECTIVE: To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema. DESIGN AND SETTING: Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil. PARTICIPANTS: Women in control phase of the breast cancer-related lymphedema. INTERVENTIONS: Compared use of ACWs versus compressive mesh. MAIN MEASURES: Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval. RESULTS: Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome-excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times. CONCLUSIONS: Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

A systematic review of the complications of skin puncturing procedures in the upper limbs of patients that have undergone procedures on the axilla or breast.

Background: The increasing incidence and prevalence of breast malignancies have led to increasing numbers of surgical interventions performed on the axilla and breast, including axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and mastectomy. The risk of postoperative complications, like breast cancer-related lymphoedema (BCRL), can have significant deleterious cosmetic and quality of life effects. National guidelines and cancer councils publish recommendations to avoid skin puncturing procedures, such as venepuncture and intravenous (IV) cannulation, on arms ipsilateral to the surgical site to prevent BCRL occurrence. The initial trials that established a link between BCRL and skin puncture were conducted in the 1950s and 1960s; the evolution of surgical management of breast cancer has likely led to large decreases in complication rates. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases were systematically searched for relevant articles. Eleven relevant articles were identified for inclusion in the final analysis. Updated Australian and New Zealand College of Anaesthetists & Faculty of Pain Medicine (ANZCA) guidelines were included in the analysis following their publication after the initial search had been completed. Results: The overall quality and quantity of evidence in this field is sufficient to conclude that skin puncturing procedures on ipsilateral arms should not be avoided in patients with previous breast or axillary surgery. The highest-quality and most recent available evidence does not support an association between BCRL and skin puncturing procedures. Policies and practices that advocate avoiding skin puncture procedures to prevent BCRL may lead to delays in clinical care. The 2023 ANZCA guidelines recommend against avoiding affected arms for peripheral access and suggest the removal of institutional policies preventing this practice. Conclusions: In patients that have undergone breast surgery or axillary procedures, venous access procedures can be safely performed on the ipsilateral arm. The evidence does not support overarching restrictions on using the ipsilateral arm without pre-existing lymphoedema.

Lymphatic Regeneration after Popliteal Lymph Node Excision and Implantation of Aligned Nanofibrillar Collagen Scaffolds: An Experimental Rabbit Model.

Lymphedema presents significant challenges to patients' quality of life, prompting the exploration of innovative treatments, such as collagen scaffolds, aimed at treating and reducing the risk of lymphedema. We aimed to evaluate the preventive and therapeutic efficacy and the lymphangiogenic potential of implanted aligned nanofibrillar collagen scaffolds (BioBridgeTM) following the induction of secondary lymphedema in a rabbit model. Thirty rabbits were divided into treatment (G1), prevention (G2), and control (G3) groups. Secondary lymphedema was induced in all groups. BioBridgeTM implantation was performed in G2 and G1 on days 0 and 60, respectively. Follow-ups included hindlimb circumference measurements and indocyanine green lymphography at 0, 60, and 90 days. None of the study rabbits exhibited dermal backflow on day 0 before surgery. At 60 days, the incidence rates of dermal backflow in G1, G2, and G3 were 100%, 44.4%, and 90%, respectively. Furthermore, at 90 days, the incidence rates were 22.2%, 44.4%, and 90%, respectively. New linear lymphatic observation was seen in rabbits with resolved dermal backflow. The findings of this study demonstrated the capacity of BioBridgeTM scaffolds to induce new lymphatic vessel formation and reduce dermal backflow in secondary lymphedema in a rabbit model.

Massive scrotal elephantiasis: A case report.

The condition known as scrotal elephantiasis is a debilitating rarity where the scrotum undergoes significant swelling, typically arising from chronic obstructive lymphedema. A case is presented of a 60-year-old man who had suffered severe and persistent enlargement of his scrotum for multiple years. This affliction greatly affected both his ability to function effectively and caused detrimental psychosocial consequences. After a clinical evaluation, the patient was diagnosed with scrotal elephantiasis. A comprehensive strategy was adopted, utilizing scrotal volume reduction surgery to yield a significant enhancement in the quality of life following the operation.

Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: Long-term results of a randomized controlled trial.

BACKGROUND: Robotic-assisted laparoscopic surgery (RALS) has become a widely and increasingly used modality of minimally invasive surgery in the treatment of endometrial cancer (EC). Due to its technical advantages, RALS offers benefits, such as a lower rate of conversions compared to conventional laparoscopy (CLS). Yet, data on long-term oncological outcomes after RALS is scarce and based on retrospective cohort studies only. OBJECTIVES: This study aimed to assess overall survival (OS), progression-free survival (PFS), and long-term surgical complications in EC patients randomly assigned to RALS or CLS. STUDY DESIGN: This randomized controlled trial was conducted at the Department of Gynecology and Obstetrics of Tampere University Hospital, Finland. Between 2010 and 2013, 101 patients with low-grade EC scheduled for minimally invasive surgery were randomized preoperatively 1:1 either to RALS or CLS. All patients underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. A total of 97 patients (49 in the RALS group and 48 in the CLS group) were followed up for a minimum of 10 years. Survival was analyzed using Kaplan-Meier curves, log-rank test, and Cox proportional hazard models. Binary logistic regression analysis was used to analyze risk factors for trocar site hernia. RESULTS: In the multivariable regression analysis, OS was favorable in the RALS group (HR 0.39; 95% CI, 0.15-0.99, p=.047) compared to the CLS group. There was no difference in PFS (log-rank test, p=.598). The three-, 5- and 10-year OS were 98.0% (95% CI, 94.0-100) vs. 97.9% (93.8-100), 91.8% (84.2-99.4) vs. 93.7% (86.8-100), and 75.5% (64.5-87.5) vs. 85.4% (75.4-95.4) in the CLS and the RALS group, respectively. Trocar site hernia developed more often in the RALS group compared to the CLS group 18.2% vs. 4.1% (OR 5.42, 95% CI, 1.11-26.59, p=.028). The incidence of lymphocele, lymphedema, or other long-term complications did not differ between the groups. CONCLUSIONS: The results of this RCT suggest a minor OS benefit in EC after RALS compared to CLS. Hence, the use of RALS in the treatment of EC seems safe, but larger RCTs are needed to confirm the potential survival benefit of RALS. No alarming safety signals were detected in the RALS group since the rate of long-term complications differed only in the incidence of trocar site hernia.

Tissue-engineered cellulose tubes for microvascular and lymphatic reconstruction: A translational and feasibility study.

BACKGROUND: Lymphedema microsurgery is an emerging treatment modality, with dissimilar long-term outcomes. One of the main technical challenges in lymphatic microsurgery is the identification and availability of suitable donor vessels for anastomosis. Tissue engineering using biomaterials has demonstrated promise in addressing vessel quality issues in other fields, but its application in microsurgery is still limited. METHODS: Decellularized cellulose tubes were developed and bioengineered by decellularizing stems of Taraxacum-Ruderalia. The microscopic structure, mechanical properties, and residual DNA content of the cellulose tubes were evaluated. Human and murine skin fibroblasts and dermal lymphatic endothelial cells were isolated and cultured for recellularization studies. Biocompatibility, proliferative capacity, and ex-vivo endothelialization of the cellulose tubes were assessed as potential interposition grafts. Finally, the engineered cellulose tubes were assessed as interposing xenografts for lymphovenous anastomoses (LVA) in an ex-vivo swine limb model. RESULTS: The decellularized cellulose tubes exhibited a suitable microscopic structure, mechanical properties, and low residual DNA content. The tubes showed adequate biocompatibility, supported cell proliferation, and facilitated spontaneous ex-vivo endothelialization of lymphatic endothelial cells. In the swine limb model, LVA using the engineered cellulose tubes was successfully performed. CONCLUSION: This translational study presents the use of decellularized cellulose tubes as an adjunct for micro and supermicrosurgical reconstruction. The developed tubes demonstrated favorable structural, mechanical, and biocompatible properties, making them a potential candidate for improving long-term outcomes in lymphedema surgical treatment. The next translational step would be trialing the obtained tubes in a microsurgical in-vivo model.

Arm symptom pattern among breast cancer survivors with and without lymphedema: a contemporaneous network analysis.

BACKGROUND: Arm symptoms commonly endure in post-breast cancer period and persist into long-term survivorship. However, a knowledge gap existed regarding the interactions among these symptoms. This study aimed to construct symptom networks and visualize the interrelationships among arm symptoms in breast cancer survivors (BCS) both with and without lymphedema (LE). PATIENTS AND METHODS: We conducted a secondary analysis of 3 cross-sectional studies. All participants underwent arm circumference measurements and symptom assessment. We analyzed 17 symptoms with a prevalence >15%, identifying clusters and covariates through exploratory factor and linear regression analysis. Contemporaneous networks were constructed with centrality indices calculated. Network comparison tests were performed. RESULTS: 1116 cases without missing data were analyzed, revealing a 29.84% prevalence of LE. Axillary lymph node dissection [ALND] (vs sentinel lymph node biopsy [SLNB]), longer post-surgery duration, and radiotherapy significantly impacted overall symptom severity (P < .001). "Lymphatic Stasis," "Nerve Injury," and "Movement Limitation" symptom clusters were identified. Core symptoms varied: tightness for total sample network, firmness for non-LE network, and tightness for LE network. LE survivors reported more prevalent and severe arm symptoms with stronger network connections than non-LE group (P = .010). No significant differences were observed among different subgroups of covariates (P > .05). Network structures were significantly different between ALND and SLNB groups. CONCLUSION: Our study revealed arm symptoms pattern and interrelationships in BCS. Targeting core symptoms in assessment and intervention might be efficient for arm symptoms management. Future research is warranted to construct dynamic symptom networks in longitudinal data and investigate causal relationships among symptoms.

Changes on noncontrast magnetic resonance imaging following lymphatic surgery for upper extremity secondary lymphedema.

OBJECTIVE: To assess changes in noncontrast magnetic resonance imaging (MRI)-based biomarkers after upper extremity lymphedema surgery. METHODS: We retrospectively identified secondary upper extremity lymphedema patients who underwent vascularized lymph node transplant (VLNT), debulking lipectomy, or VLNT with a prior debulking (performed separately). All patients with both preoperative and postoperative MRIs were compared. An MRI-based edema scoring system was used: 0 (no edema), 1 (<50% fluid from myofascial to dermis), and 2 (≥50% fluid from myofascial to dermis). Edema scores and subcutaneous thickness (ST) were obtained along four quadrants across the upper and lower third of the arm and forearm each-for a total of 16 anatomical locations-and compared before and after surgery. Net changes in edema scores and ST were then correlated with Lymphoedema Quality-of-Life Questionnaire scores, L-Dex (bioimpedance), and limb volume difference by perometry. RESULTS: Patients who underwent lymphatic surgeries between January 2017 and December 2022 and successfully completed preoperative and postoperative MRI were included, resulting in a total of 33 unilateral secondary upper extremity lymphedema patients m(mean age, 63 ± 14 years; 32 female). The median postoperative follow-up times were 12.5 months (range, 6-19 months) for VLNT, 13.5 months (range, 12-40 months) for debulking, and 12.0 months (range, 12-24 months) for patients who underwent VLNT after debulking surgery. There was a decrease in mean ST in 15 of 16 anatomical segments of the upper extremity after debulking (P < .001), and the edema score increased in 7 of 16 segments (P ≤ 2). Edema stage did not change in patients who underwent VLNT only or VLNT after debulking. ST decreased only along the radial forearm in patients who underwent VLNT after debulking despite an improvement in the Lymphoedema Quality-of-Life Questionnaire score in the former group. There was correlation between a decrease in ST with a decrease in volume within the debulking group (r = 0.79; P < .001). A decrease in ST also correlated with improved lymphedema-specific quality of life questionnaires in the debulking group (r = 0.49; P = .04). CONCLUSIONS: A decrease in ST was demonstrated in most anatomical segments after liposuction debulking, whereas edema stage was increased. Fewer changes were seen with VLNT, possibly a reflection of more gradual changes within this short follow-up period, with the radial forearm potentially revealing the earliest response.

LYMPH-Q translation, cultural adaptation and validation in Italian language: A prospective PROMs-based study on breast cancer-related arm lymphedema for patients' education.

BACKGROUND: Upper Extremity Lymphedema following oncological breast surgery affects not only the patient's physique, but also the patient's psychological sphere. One of the best known PROMs-based questionnaires for investigating the condition is the LYMPH-Q. The study aimed to perform the Italian translation and cultural adaptation of the LYMPH-Q and to assess if, independently from disease evolution, arm sleeve improves QoL in these patients. MATERIALS AND METHODS: Translation included 4 steps: Forward translation, Back translation, Back translation review and Patient interviews. The questionnaire was administered to 50 female patients older than 18 years of age with UEL who received a prescription for daily use of a compression sheath. A second administration took place 30 days after. Forty-four patients completed the study (Group 1: 26 patients with indication to use compression sleeve who wore it; Group 2:18 patients who despite the prescription did not want to wear it. A descriptive statistical analysis was performed with Prism 9 software. RESULTS: T-tests showed statistical significance for changes in "Symptoms," "Function," "Appearance" and "Psychological" scales. There were no statistically significant changes for "Information scale" in Group 1 and for all scales in Group 2. CONCLUSION: Data from this observational study show that HR-QOL analyzed from the patients' perspective also tends to improve in terms of symptoms, function, appearance, and psychological sphere in patients with BCRL when using a compression sheath. The Lymph-Q has proven to be a valuable ally of the physician attempting to improve treatment approaches for BCRL based not only on scientific evidence but also on PROMs.

Management of a Large Abdominal Desmoid Tumor Complicated by Lymphedema of the Lower Limb: A Case Report.

Desmoid tumors, while generally benign histologically, can exhibit locally aggressive behavior, especially when located in the anterior abdominal wall. This case report explores the management of a rare giant desmoid tumor complicated by concurrent lymphedema, emphasizing the nuances of diagnosis, treatment decisions, and their impact on the patient's quality of life. The patient, a 55-year-old obese individual with a BMI of 47, presented with a 25 cm mass in the right paraumbilical region, alongside significant lymphedema in the right lower limb and associated inguinal lymphadenopathy. Abdominal CT revealed a well-defined soft tissue mass in the right paramedian hypogastric region, suggestive of a desmoid tumor. Surgical intervention involved a monobloc resection of the mass with a 5 cm lateral margin, including the right rectus abdominis muscle and associated aponeuroses, and subsequent reconstruction using a biface intraperitoneal synthetic mesh. Postoperative recovery was marked by the resolution of lymphedema and a return to full function of the affected limb. Histopathological examination confirmed the diagnosis of a desmoid tumor. This case underscores the importance of radical surgical resection with adequate margins and appropriate reconstruction to achieve favorable long-term outcomes. The report provides insights for future research and therapeutic advancements in the management of desmoid tumors.

Patterns of forearm lymphatic drainage to the epitrochlear lymph nodes in 1400 cutaneous melanoma patients.

BACKGROUND: Variations of hand and forearm lymphatic drainage to upper-arm lymphatic pathways may impact the route of melanoma metastasis. This study compared rates of lymphatic drainage to epitrochlear nodes between anatomic divisions of the hand and forearm to determine whether the anatomic distribution of hand and forearm melanomas affects the likelihood of drainage to epitrochlear lymph nodes. METHODS: Using a single-institution lymphoscintigraphy database, we identified all patients with cutaneous melanoma on the hand and forearm. A body-map two-dimensional coordinate system was used to classify cutaneous melanoma sites between radial-ulnar and dorsal-volar divisions. Sentinel lymph nodes (SLNs) visualized on lymphoscintigraphy were recorded. Proportions of patients with epitrochlear SLNs were compared between anatomic divisions using χ2 analysis. RESULTS: Of 3628 upper extremity cutaneous melanoma patients who underwent lymphatic mapping with lymphoscintigraphy, 1400 met inclusion criteria. Twenty-one percent of patients demonstrated epitrochlear SLNs. Epitrochlear SLNs were observed in 27% of dorsal forearm melanomas and 15% of volar forearm melanomas (p < 0.001). Epitrochlear SLNs were observed in 31% of ulnar forearm melanomas and 17% of radial forearm melanomas (p < 0.001). CONCLUSIONS: Higher proportions of dorsal and ulnar forearm melanomas have epitrochlear SLNs. Metastasis to epitrochlear SLNs may be more likely from melanomas in these respective forearm regions.

Morel-Lavallee associated lymphedema treated with lymphovenous anastomosis: A case report.

Morel-Lavallee Lesions lead to disruption of lymphatic anatomy that require early identification and may necessitate lymphatic reconstruction. We present the case of a 59-year-old male with lower extremity lymphedema resulting after a severe Morel-Lavallee lesion and treated using lymphovenous anastomoses. He was initially managed with multiple aspirations followed by repeat incision and drainage. At 10 months following his injury, he continued to have swelling of his upper thigh and developed a large festoon medially, with lower leg pitting edema. He was diagnosed with lymphedema via lymphoscintigraphy. His superficial lymphatic anatomy was visualized using indocyanine green (ICG) lymphography and showed diffuse dermal backflow across his thigh, with signs of altered lymphatic anatomy distally. We preformed two lymphovenous anastomoses at the level of his mid-thigh to bypass the lymphatic disruption and restore drainage to his lower leg. After rerouting lymphatic flow from the lower extremity, the patient had overall improvement of his symptoms and reduced swelling with continued therapy. At 5 months postoperatively, his volumetric lower extremity measurements showed a decrease by 314 mL and he began walking again in 20-minute intervals. Lymphedema may be an important consideration following severe Morel-Lavallee lesions. Using modern diagnostic and supermicrosurgical techniques, plastic surgeons can help treat this long-term morbidity.

Current trends in breast cancer surgery.

The incidence of breast cancer has been increasing significantly over the past decades, while the mortality rate has, actually, been decreasing. Behind this favorable trend in the decrease in mortality are not only high-quality screening programs, but also undoubtedly advances in therapy, especially new methods in surgical treatment. The importance of oncoplastic approach integrating resection and reconstruction procedures is obvious. Our efforts continue to maximize breast-conserving therapy, which is being improved in parallel with the development of new localization methods of non-palpable lesions. Breast-conserving therapy indication spectrum is also increasing with the use of oncoplastic approach allowing the resection of a significant part of the mammary gland while achieving an acceptable cosmetic result. We improve guidelines for skin-sparing procedures and also possibilities and availability of breast reconstruction. Most popular is breast reconstruction with free abdominal flap transfer. However, due to such demanding complex procedure with limited availability, there is also a significant development of silicone-implant-based reconstruction or methods of fat transfer. Constant attention is focused on axillary surgery, now especially in cases of initial nodal involvement that responds favorably to neoadjuvant systemic treatment. Current findings indicate tendency to modify and differentiate surgical indications according to the tumor phenotype. Complex lymphedema prevention surgery, such as lymphatic mapping or restoring lymphatic flow via microsurgical lymphaticovenous anastomosis, can provide effective and long-term improvement and is challenging. Recently in the Czech Republic, we reopened the discussion about the optimal concentration of medical care in a smaller number of specialized breast centers, which we think is one of a number of steps on the constant path to improve medical results.