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A Journal on Angiology
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,899
International Angiology 2015 Nov 23
Treatment of postmastectomy lymphedema by bypassing the armpit with implanted silicone tubings
Olszewski W. L. 1, 2, 3, Zaleska M. 1 - 4 ✉
1 Central Clinical Hospital, Ministry of Home Affairs, Dept. of Vascular Surgery, Warsaw, Poland;
2 Mossakowski Medical Research Center, Polish Academy of Sciences, Dept. of Transplantation Surgery, Warsaw, Poland;
3 Mossakowski Medical Research Center, Polish Academy of Sciences, Dept. of Epigenetics, Warsaw, Poland;
4 Mossakowski Medical Research Center, Polish Academy of Sciences, Dept. of Applied Physiology, Warsaw, Poland
OBJECTIVES: Women treated for breast cancer are facing a life-time risk of developing lymphedema in up to 40% of this population. In advanced cases of lymphedema main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces forming fluid “lakes”and “channels”. The only solution for fluid drainage would be creating artificial channel for flow away to the non-obstructed regions.
AIM: To form artificial pathways for edema fluid flow by subcutaneous implantation of silicone tubes into the swollen limb.
MATERIAL AND METHODS: Implantation was carried out in 10 patients with lymphedema after mastectomy, axillary lymphadenectomy and radiotherapy, stage II and III. Tubes were placed from hand dorsum, through forearm and arm to scapular region. Implantation was followed by routine arm sleeve compression. Prophylactic long term penicillin was administered. The follow up is at present 10 months.
RESULTS: a) implanted tubes brought about fast evacuation of excess tissue fluid, b) most decrease in circumference, volume and stiffness occurred within first two weeks, c) less limb heaviness and easier hand grip, d) lymphoscintigraphy tracer accumulated in tubes and around them, e) free fluid was seen on ultrasonography at both ends of tubes and in between , e) no postoperative complications.
CONCLUSIONS: We propose a multimodality method including implantation, limb compression to generate fluid pressure gradient for flow and prevention of inflammation by administration of long-term penicillin. Simplicity of surgical procedure and lack of reaction to implant make the method worth applying in advanced stages of lymphedema in large cohorts of patients.