Page 18 - Read Online

Yesantharao et al. Plast Aesthet Res 2022;9:60 https://dx.doi.org/10.20517/2347-9264.2022.67 Page 11 of 13

As previously described, nanofibrillar collagen scaffolds represent a viable physiologic therapy for secondary
lymphedema that is minimally invasive and does not require microsurgical technique. Further work should
investigate the relative cost-effectiveness of using these scaffolds in secondary lymphedema patients to
better understand their utility in high-volume lymphedema centers as well as their applicability to low-
resource settings. Additionally, understanding the cost-effectiveness of these scaffolds can help inform
reimbursement and coverage for these procedures, as acquired lymphedema remains a substantial
survivorship issue amongst cancer patients .
[32]

In conclusion, this article reviewed novel tissue engineering efforts for the treatment of secondary
lymphedema, with a particular focus on nanofibrillar collagen scaffolds. Overall, these scaffolds have
demonstrated promise in augmenting lymphangiogenesis upon both preclinical and clinical testing, and
they have been demonstrated to improve secondary lymphedema outcomes when used both preventatively
and therapeutically.

DECLARATIONS
Authors’ contributions
Contributed to conception and design, acquisition, analysis, interpretation of data, manuscript writing, and
final approval of manuscript: Yesantharao PS, Nguyen DH

Availability of data and materials
Study articles and data are available at reasonable request of the corresponding author.

Financial support and sponsorship
None.

Conflicts of interest
Dr. Dung H. Nguyen is the Principal Investigator of ongoing clinical trials of BioBridge in lymphedema
patients. Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.

REFERENCES
1. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and
meta-analysis of cancer-related secondary lymphedema. Cancer 2010;116:5138-49. DOI PubMed
2. Armer JM, Stewart BR. Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 2010;43:118-
27. PubMed PMC
3. Chang DW, Masia J, Garza R 3rd, Skoracki R, Neligan PC. Lymphedema: surgical and medical therapy. Plast Reconstr Surg
2016;138:209S-18S. DOI PubMed
4. Rochlin DH, Inchauste S, Zelones J, Nguyen DH. The role of adjunct nanofibrillar collagen scaffold implantation in the surgical
management of secondary lymphedema: Review of the literature and summary of initial pilot studies. J Surg Oncol 2020;121:121-8.
DOI PubMed
5. Welch V, Petticrew M, Tugwell P, et al; PRISMA-Equity Bellagio group. PRISMA-Equity 2012 extension: reporting guidelines for
systematic reviews with a focus on health equity. PLoS Med 2012;9:e1001333. DOI PubMed PMC