WoundReference improves clinical decisions
 Choose the role that best describes you
Olszewski WL, Zaleska M, et al.
Journal of vascular surgery. Venous and lymphatic disorders. Date of publication 2015 Oct 1;volume 3(4):401-408.
1. J Vasc Surg Venous Lymphat Disord. 2015 Oct;3(4):401-408. doi: 10.1016/j.jvsv.2015.05.001. Epub 2015 Jun 30. A novel method of edema fluid drainage in obstructive lymphedema of limbs by implantation of hydrophobic silicone tubes. Olszewski WL(1), Zaleska M(2). Author information: (1)Department of Epigenetics, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Department of Applied Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Central Clinical Hospital, Ministry of Home Affairs, Warsaw, Poland. Electronic address: waldemar.l.olszewski@gmail.com. (2)Department of Epigenetics, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Department of Applied Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Central Clinical Hospital, Ministry of Home Affairs, Warsaw, Poland. OBJECTIVE: Lymphedema of limbs is caused by partial or total obstruction of lymphatic collectors as a consequence of skin and deep soft tissue inflammation, trauma of soft tissues and bones, lymphadenectomy, and irradiation in cancer therapy. According to the statistics of the World Health Organization, around 300 million people are affected by pathologic edema of limbs. Effective treatment of such large cohorts has been a challenge for centuries. However, none of the conservative and surgical methods applied so far proved to restore the shape and function of limbs to normal conditions. Actually, physiotherapy is the therapy of choice as a main modality or supplementary to surgical procedures divided into two groups: the bridging drainage and excisional techniques. The microsurgical operations can be performed if some parts of the peripheral collecting lymphatics remain patent and partially drain edematous regions. However, in advanced cases of lymphedema, all main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces, spontaneously forming "blind channels" or "lakes." The only solution would be to create artificial pathways for edema fluid flow away to the nonobstructed regions where absorption of fluid can take place. The aim of this study was to form artificial pathways for edema fluid flow by subcutaneous implantation of silicone tubes placed along the limb from the lower leg to the lumbar or hypogastric region. METHODS: In a group of 20 patients with obstructive lymphedema of the lower limbs that developed after lymphadenectomy and irradiation of the pelvis because of uterine cancer with unsuccessful conservative therapy, implantation was done, followed by external compression as intermittent pneumatic compression and elastic support of tissues. Postoperative circumference measurements, lymphoscintigraphy, and ultrasonography of tissues were carried out during 2 years of follow-up. RESULTS: There was a fast decrease of calf circumference since the day of implantation during weeks by a mean 3% with stabilization afterward. Patency of tubes and accumulation of fluid around them were seen on ultrasonography and lymphoscintigraphy in all cases. No tissue cellular reaction to silicone tubes was noted. CONCLUSIONS: The simplicity of the surgical procedure, decrease of limb edema, and lack of tissue reaction to the implant make the method worth applying in advanced stages of lymphedema with large volumes of accumulated tissue edema fluid. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jvsv.2015.05.001 PMID: 26992618 [Indexed for MEDLINE]
Appears in following Topics:
Lymphedema - Treatment and Emerging Strategies for Prevention