Anatomical and Surgical Concepts in Lymphatic Regeneration

Modified Combined Physiological and Debulking Procedure for Lower Limb Lymphedema to Achieve Both Immediate and Sustained Results in Lymphedema

A 17-year-old girl presented with bilateral lower limb lymphedema since 3 years. Lymphedema in the right leg was Grade III, not pitting and not reducing in size after limb elevation. She hailed from a tribal community. Considering her young age, a single-stage operative procedure for her lymphedematous leg was followed, as she was not prepared for a multistaged operation. However, this operative procedure needed to be a combination of both, debulking and physiological procedures, so as to give her immediate limb girth reduction as well as reduction in recurrence, as seen with debulking procedures. We report a newer technique that could achieve both goals.

Study on the Design and Optimization of a Portable Monitoring and Auxiliary Treatment Device for Upper Extremity Lymphedema-Focus on the Rehabilitation Function of the Device

Female patients suffer from the risk of upper limb lymphedema after breast cancer removal surgery. At present, the detection and the adjuvant treatment of this disease are not convenient enough, leading to delay of the disease and increase in the burden of patients. This paper presents a portable monitoring and treatment device for upper extremity lymphedema, enabling patients to monitor the symptoms of upper limb lymphedema and auxiliary rehabilitation. This design utilizes the arm circumference measurement and contrast method to realize symptom monitoring. The device realizes auxiliary rehabilitation using the regional pressure method to imitate traditional manual lymphatic drainage technology. According to the MRI images of volunteers’ upper limbs, the upper arm and forearm’s finite element models are reconstructed in ANSYS. The static simulation experiment is completed. The working mode and parameter design of each rehabilitation module of the device are obtained. The experimental results show that the integrated design principle of monitoring and treatment proposed in this paper has good feasibility, has auxiliary rehabilitation effect, and meets the principle of human comfort. The device can help patients find lymphedema in time and implement auxiliary treatment, which can effectively avoid the further deterioration of lymphedema.

Animal Models of Secondary Lymphedema: New Approaches in the Search for Therapeutic Options

Secondary lymphedema is still a worldwide problem. Symptomatic approaches to lymphedema therapy have been mainly used, with complete decongestive therapy as the cornerstone. Due to a lack of regenerative therapy, researchers have established various animal models to obtain insights into pathomechanisms and to reveal the best therapeutic option. Since the first reproducible and reliable animal model of lymphedema was reported in dogs, the technique of circumferential excision of lymphatic tissue has been translated mainly to rodents to induce secondary lymphedema. In these models, various promising pharmacological and surgical approaches have been investigated to improve secondary lymphedema therapy. Imaging modalities are crucial to detect the extent of lymphatic dysfunction and decide the best therapy. The gold standard of lymphoscintigraphy is currently limited by poor spatial resolution and lack of quantification. Animal models could help to bridge a gap in improving morphological correlation and quantifying lymphatic functionality. This review summarizes the animal models used in lymphatic research and focuses on new therapeutic options and requirements for imaging modalities to visualize the lymphatic system.

The link between lymphedema, breast reconstruction and microsurgery

SUMMARY 

This management perspective will explore the relationship between lymphedema and breast reconstruction surgery. Little data exist, but early reports suggest breast reconstruction may be associated with a lower risk of lymphedema. Theories surrounding this relationship, as well as available data on lymphatic repair theories, will be discussed. In addition, the emerging role of lymphatic surgery to prevent or reverse lymphedema will be discussed. The refinement of advanced microsurgical techniques has resulted in a renewed interest in lymphatic surgery to cure lymphedema. However, efficacy, validation of surgical results, and surgery's ability to eliminate from patients the need for daily compression garments and therapy need further study.