Page 81 - Read Online

Page 2 of 12 Lasso. Plast Aesthet Res 2020;7:30 I http://dx.doi.org/10.20517/2347-9264.2019.75

lymphatic activity compatible with lymph nodes was detectable after LVA. The Spearman correlation coefficient
was negative when circumferences and lympho-SPECT-CT were tested (P = 0.02).

Conclusion: Results showed a postoperative decrease in volume that correlated inversely with lympho-SPECT/CT
findings. Lympho-SPECT/CT provided additional information related to accurate identification and the anatomical
location of lymphatic structures that were not observed before reconstructive surgery. It can be a complementary
test to conventional lymphoscintigraphy.

Keywords: Lymphedema, supermicrosurgery, lymphovenous anastomosis, LVA, lympho-SPECT/CT, ICG

INTRODUCTION
Lymphedema is a debilitating disease in which drainage of the lymphatic system is impaired and affects
a considerable number in the population. In developed countries, this is prevalent after pelvic or axillary
radiotherapy, and lymph node dissection following oncologic surgery of the breast or pelvis. Unfortunately,
secondary lymphedema and especially, primary lymphedema are still pathological conditions that cannot
be treated definitively. Treatment prospects however, have improved for patients in the last decade due to
new surgical techniques.

[1-4]
Current surgical treatments are based on microsurgical techniques . The two main procedures are: lymph
node transfer and lymphovenous anastomosis (LVA). Preoperative clinical evaluation of the patients and
imaging studies of the lymphatic system are essential when surgery is planned for. On the other hand,
postoperative imaging methods are crucial for understanding the efficacy of surgery.

Among these methods, lympho-SPECT/CT seems to be effective in evaluating lymphatic flow and to
document lymph node regeneration. Previous publications have found that it should be a principal tool to
[5]
complete functional evaluation of lymphedema .

We report a prospective study in 20 patients with secondary lymphedema that was treated with LVA.
The degree of lymphedema ranged from II to III (ISL classification). Our main goal was to describe new
findings using lympho-SPECT-CT images before and after surgery and to correlate these results with the
respective volume changes.

METHODS
An observational, prospective, longitudinal study was designed. 20 consecutive patients treated with LVA
for lymphedema at the Hospital Gregorio Marañón in Madrid between 2015 and 2018 were included. All
were affected by secondary lymphedema of the lower or upper limbs following surgical lymphadenectomy,
radiation or both. Patients were randomly selected in out-patient hospital. The inclusion criteria were:
secondary lymphedema of a limb; no previous reconstructive surgery of the lymphatic system; patients with
previous rehabilitation therapy were considered for inclusion in the study; those with an ISL classification
of lymphedema of degree II and II; and lymphedema had to be established for at least one year before
reconstructive microsurgery.

Clinical evaluation
Pre- and postoperative evaluation was based on imaging and clinical examination. Limb circumference
was measured at every 5 cm: point 1 - mid-palm or mid-foot, point 2 - bony landmarks (ulnar styloid
process/lateral malleolus), C3-C8 - every 5 cm above point 2. The variable used for evaluation and follow-
up was the circumference difference, which is equal to the sum of the differences between the involved