Aberrant innominate artery: A possible hazard during total laryngectomy.

BACKGROUND: Surgical management in laryngeal carcinoma remains a challenge with countless unexpected complications. Great vessel anomalies such as anomaly of the innominate artery carry high risk of morbidity and mortality if not managed properly. METHODS: We present our first experience with an aberrant innominate artery during total laryngectomy which complicated the whole surgical procedure and tracheostoma placement. RESULTS: We decided to place a pectoralis major muscle flap to separate and cover up the aberrant vessel from the trachea and end-stoma which ultimately did not lead to major complications postoperatively and postradiation therapy. CONCLUSION: Aberrant innominate artery is an extremely rare entity and failure of recognizance can lead to hazardous complications. Preoperative angiography needs to be done if there are high suspicions of aberrant vessels in the operative field. Careful dissection of the head and neck region, and prompt decision making are mandatory to manage such cases. LEVELS OF EVIDENCE: Case Report.

Effect of Lymphaticovenous Anastomosis in Breast Cancer-Related Lymphedema: A Review of the Literature.

BACKGROUND: Lymphedema affects ∼15% of all patients after breast cancer treatment. The aim of this review was to assess the clinical effects (improvement in arm circumference and quality of life) of lymphaticovenous anastomosis (LVA) in treating breast cancer-related lymphedema (BCRL). METHODS AND RESULTS: A systematic literature search was conducted in Medline, Embase and the Cochrane Library in July 2017, to identify all studies on LVA for the treatment of BCRL. The primary outcome was limb volume or circumference reduction and the secondary outcome was the improvement of quality of life. The search yielded 686 results, of which 15 articles were included in this review. All studies reported on BCRL in terms of volume or circumference reduction. Thirteen out of the included studies reported a positive surgical effect on reduction in volume or circumference. Twelve articles mentioned qualitative measures, being symptom improvement and improvement in quality of life. The number of patients who experienced symptoms relief ranged from 50% to 100% in the studies. CONCLUSIONS: The current review showed that the effects of LVA for the treatment of BCRL are variable among studies, although overall LVA seems effective in early stage BCRL. Higher quality studies are needed to confirm the effectiveness of LVA.