Olszewski WL, Zaleska M, et al.
International angiology : a journal of the International Union of Angiology. Date of publication 2017 Feb 1;volume 36(1):50-58.
1. Int Angiol. 2017 Feb;36(1):50-58. doi: 10.23736/S0392-9590.16.03630-0. Epub 2015
Nov 23.
Treatment of postmastectomy lymphedema by bypassing the armpit with implanted
silicone tubings.
Olszewski WL(1), Zaleska M(2).
Author information:
(1)Department of Vascular Surgery, Central Clinical Hospital, Ministry of Home
Affairs, Warsaw, Poland - waldemar.l.olszewski@gmail.com; Department of
Transplantation Surgery, Mossakowski Medical Research Center, Polish Academy of
Sciences, Warsaw, Poland; Department of Epigenetics, Mossakowski Medical Research
Center, Polish Academy of Sciences, Warsaw, Poland.
(2)Department of Vascular Surgery, Central Clinical Hospital, Ministry of Home
Affairs, Warsaw, Poland; Department of Transplantation Surgery, Mossakowski
Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; 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.
BACKGROUND: 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. The aim of this study was to form artificial pathways for
edema fluid flow by subcutaneous implantation of silicone tubes into the swollen
limb.
METHODS: Implantation was carried out in ten 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: We observed: implanted tubes brought about fast evacuation of excess
tissue fluid; most decrease in circumference, volume and stiffness occurred
within first two weeks; less limb heaviness and easier hand grip;
lymphoscintigraphy tracer accumulated in tubes and around them; free fluid was
seen on ultrasonography at both ends of tubes and in between; 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.
DOI: 10.23736/S0392-9590.16.03630-0
PMID: 26603434 [Indexed for MEDLINE]
