Innovative method of complete surgical rehabilitation of patients with lymphedema
Abstract
Objective. To develop a concept that allows complete rehabilitation of patients with postmastectomy lymphostasis. Often in patients with secondary lymphatic edema of the hand after complex treatment of breast cancer breast is completely resected. The optimal approach in this case is the maximum restoration of the former anatomy for a minimum number of surgical interventions. Materials and methods. 25 patients with postmastectomy lymphostasis are included in the study. Inclusion criteria: absence of breast and presence of lymphostasis of the hand. All patients underwent BRANT operation (Breast Reconstruction And Node Transplantation), which implies microsurgical auto transplantation of inguinal lymph flap in the axillary region and use any of the available autologous grafts or combination of materials and silicone implants for breast reconstruction volume. Results. The average regression of the edema after 1 year after surgery was 70%. Quality of life and social activity of patients increased significantly. All patients of working age were able to return to work after 1-2,5 months after the operation. Conclusions. BRANT allows for a minimum number of surgical interventions to restore the attractive look of breast and to achieve good results in the treatment of hands lymphoedema. An important aspect of this approach is full fledged social rehabilitation of patients.
About the Authors
V. Ju. Ivashkov
FGBU «National Medical Research Center of Oncology named after N.N. Blokhin» of the Ministry of Health of Russia
Russian Federation
Russian Federation
V. A. Sobolevsky
FGBU «National Medical Research Center of Oncology named after N.N. Blokhin» of the Ministry of Health of Russia
Russian Federation
Russian Federation
References
1. Ивашков ВЮ, Сопромадзе СВ, Доколин РМ, Алымов ЮВ. Применение метода гипербарической оксигенации для лечения осложнений после реконструктивных операций в онкологии. Саркомы костей, мягких тканей и опухоли кожи. 2017; (1): 46-51.
2. Tashiro K, Feng J, Wu SH et al. Pathological changes of adipose tissue in secondary lymphedema. Br J Dermatol. 2016; 21(2): 168-172.
3. Kobayashi MR, Miller TA. Lymphedema. Clin Plast Surg. 1987; 14: 303-313.
4. Ивашков ВЮ, Соболевский ВА. Клинический случай лечения длительной лимфорреи, возникшей после радикальной мастэктомии. Поволжский онкологический вестник. 2015; (3): 20-23.
5. Выренков ЮЕ, Полинов AB, Опенкин AB. Эффективность лимфо-венозного анастомоза при экспериментальном лимфостазе конечностей. Хирургия. 1979; (9): 8-10.
6. Махов НИ. Новый метод лечения слоновости путем пересадки лимфатических протоков бедра в большую подкожную вену. Демонстрация на хирургическом обществе г. Москвы и области. Хирургия. 1950; (12): 69-70.
7. Koshima I, Nanba Y, Tsutsui T et al. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg. 2003; 19 (4): 2o9-215.
8. Olszewski WL. Fifteen years experience in treatment of pa-cients with postsurgical and primary lymphedema of lower limbs with surgical lymphovenous anastomosis: Advances in Lymphology. Eds. V. Bartos. Prague: Avictnum. 1982: 493496.
9. Юсупов ИА. Хирургическое восстановление лимфатических путей и свободная аутотрансплантация лимфатических узлов по лимфографическим данным. Автореф. дисс.. канд. мед. наук. 1968.
10. Cheng MH, Huang JJ, Nguyen DH et al. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Gynecol Oncol. 2012; 126: 93Y98.
11. Saaristo AM, Niemi TS, Viitanen TP et al. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg. 2012; 255: 468-473.
12. Maegawa J, Yabuki Y, Tomoeda H et al. Outcomes oflymphati-covenous side-to-end anastomosis in peripheral lymphedema. J Vascular Surgery. 2012; 55(3): 753-760.
13. Masia J. T-BAR: Total Breast Anatomy Restoration. Current Challenges in Total Breast Reconstruction II: сб. Выст. участников международного форума «Barcelona Breast Meeting» (Барселона, 13-15 марта 2013 г.). Барселона, 2013.
14. Ивашков ВЮ, Соболевский ВА. Хирургическое лечение лимфатического отека верхних конечностей у пациентов после комплексного лечения рака молочной железы. Современное состояние проблемы. Анналы пластической и реконструктивной хирургии. 2015; (3): 15-18.
15. Ивашков ВЮ. Пересадка васкуляризированных лимфатических узлов в лечении лимфатического отека руки. Анатомическое исследование пахового лимфатического лоскута. Методика двойного контрастирования лимфоузлов. Саркомы костей, мягких тканей и опухоли кожи. 2016; (2): 61-67.
16. Gousopoulos E, Proulx ST, Bachmann SB et al. Regulatory T-cell transfer ameliorates lymphedema and promotes lymphatic vessel function. JCI Insight. 2016; 1(16): є89081.
Review
For citations:
Ivashkov V.J., Sobolevsky V.A. Innovative method of complete surgical rehabilitation of patients with lymphedema. Bone and soft tissue sarcomas, tumors of the skin. 2018;10(1):56-62. (In Russ.)
Views:
147
Email this article 
