The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up
Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never b...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/3/570 |
| _version_ | 1797487039316230144 |
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| author | Luigi Losco Alberto Bolletta Alessandro de Sire Shih-Heng Chen Gokhan Sert Dicle Aksoyler Jonathan Velazquez-Mujica Marco Invernizzi Emanuele Cigna Hung-Chi Chen |
| author_facet | Luigi Losco Alberto Bolletta Alessandro de Sire Shih-Heng Chen Gokhan Sert Dicle Aksoyler Jonathan Velazquez-Mujica Marco Invernizzi Emanuele Cigna Hung-Chi Chen |
| author_sort | Luigi Losco |
| collection | DOAJ |
| description | Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 ± 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 ± 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (<i>p</i> < 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, <i>p</i> = 0.006 and <i>p</i> = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 ± 0.9 to 6.2 ± 0.8 (<i>p</i> < 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time. |
| first_indexed | 2024-03-09T23:41:58Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:41:58Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-817c18c9fa274c3b86768d37c453c1a62023-11-23T16:50:32ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111357010.3390/jcm11030570The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-UpLuigi Losco0Alberto Bolletta1Alessandro de Sire2Shih-Heng Chen3Gokhan Sert4Dicle Aksoyler5Jonathan Velazquez-Mujica6Marco Invernizzi7Emanuele Cigna8Hung-Chi Chen9Department of Plastic Surgery, China Medical University, Taichung 404, TaiwanDepartment of Plastic Surgery, China Medical University, Taichung 404, TaiwanPhysical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, ItalyDepartment of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan City 33305, TaiwanDepartment of Plastic Surgery, China Medical University, Taichung 404, TaiwanDepartment of Plastic Surgery, China Medical University, Taichung 404, TaiwanDepartment of Plastic Surgery, China Medical University, Taichung 404, TaiwanPhysical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, ItalyDepartment of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, ItalyDepartment of Plastic Surgery, China Medical University, Taichung 404, TaiwanBackground: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 ± 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 ± 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (<i>p</i> < 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, <i>p</i> = 0.006 and <i>p</i> = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 ± 0.9 to 6.2 ± 0.8 (<i>p</i> < 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time.https://www.mdpi.com/2077-0383/11/3/570lymphedemalymphedema of the lower limbsLYMQoL questionnairequality of lifevascularized lymph node transferlymph node flap |
| spellingShingle | Luigi Losco Alberto Bolletta Alessandro de Sire Shih-Heng Chen Gokhan Sert Dicle Aksoyler Jonathan Velazquez-Mujica Marco Invernizzi Emanuele Cigna Hung-Chi Chen The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up Journal of Clinical Medicine lymphedema lymphedema of the lower limbs LYMQoL questionnaire quality of life vascularized lymph node transfer lymph node flap |
| title | The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up |
| title_full | The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up |
| title_fullStr | The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up |
| title_full_unstemmed | The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up |
| title_short | The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up |
| title_sort | combination of lymph node transfer and excisional procedures in bilateral lower extremity lymphedema clinical outcomes and quality of life assessment with long term follow up |
| topic | lymphedema lymphedema of the lower limbs LYMQoL questionnaire quality of life vascularized lymph node transfer lymph node flap |
| url | https://www.mdpi.com/2077-0383/11/3/570 |
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