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]
