Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb: A Systematic Review and Meta-analysis of Clinical Outcomes.

BACKGROUND: Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites. METHODS: We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies. RESULTS: A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7-41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36-0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection. CONCLUSIONS: Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.

Arabic Translation and Linguistic Validation of the SCAR-Q Scale Module.

Scars are a fairly common complaint in the clinical setting; they can arise from trauma, burns, or after surgical procedures. They can have a detrimental impact on the quality of life of patients. A well-established method of quantifying such an impact is through patient-reported outcome measures (PROM). SCAR-Q is a relatively new and robust questionnaire that was developed and validated by McMaster University. Our study aims to translate SCAR-Q to Arabic. SCAR-Q has a holistic approach to scars and does not target scars of a specific etiology. It has three main components: scar appearance, psychological impact, and symptoms associated with the scar. This translation will enable data collection, analysis, and interpretation from a previously untouched demographic. This article explains the steps taken to develop an accurate and validated Arabic SCAR-Q questionnaire based on World Health Organization (WHO) and The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines. We were able to methodically produce a validated translation of the SCAR-Q into Arabic that should potentially allow data collection and feedback from a very large segment of the world population regarding the impact of scars on their quality of life.