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Page 4 of 12 Lasso. Plast Aesthet Res 2020;7:30 I http://dx.doi.org/10.20517/2347-9264.2019.75
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acquired to obtain early (30 min) and late (2 h) images with a gamma camera (GAMMG ) and low energy-
high resolution collimator (LEHR). The acquisition from each time point proceeded over 10 min.

SPECT-CT images were acquired over 30 min, starting at 3 h after injection of the nucleotide using a
TM
dual-head combined SPECT/CT camera (Optima NM/CT640, General Electric) with the following
parameters: 128 × 128 matrix, rotation of 360º, 4º view angle, 25 s per projection; slice thickness was 2.5 mm.
Two nuclear medicine specialists reviewed all images regarding the detectability and number of lymph
nodes.

Description of imaging findings included the absence of nodes, improved drainage of the lymph node
basin, new lymphatic drainage in extra-anatomical position, and traces of the nucleotide constituting spots
along the lymphatic system of the limb. Data acquired were compared with postoperative SPECT-CT/
lymphoscintigraphy results.

Statistical analysis
Categorical variables were described as numbers and percentages. Continuous variables were described as
median (interquartile range). Lympho-SPECT-CT findings were described as: absence of nodes (0); traces
of the nucleotide constituting spots along the lymphatic system of the limb (1); improved drainage of the
lymph node basin (2); and new lymphatic drainage in extra-anatomical position - elbow, supraclavicular,
parascapular (3). Correlation between continuous variables was evaluated using the Spearman coefficient.
Statistical significance was defined as P < 0.05. IBM SPSS software was used for calculation of the above.

RESULTS
The patients’ age ranged from 25 to 76 years old, with a mean of 48.3 years. Sixteen and four patients had
upper and lower limb lymphedema respectively. Eighteen patients were female.

The duration of disease from diagnosis to LVA surgery ranged from 15 months to 11 years. Fifteen
patients had lymphadenectomy and postoperative radiotherapy (14 in the axilla and 1in the groin); four
had sentinel node biopsy and postoperative radiotherapy (2 axilla, 2 groin) and a single patient had
radiotherapy (in the groin after pelvic surgery). A mean of 4.35 (range, 2-10) anastomoses were performed
in each affected limb. In all cases, follow-up was more than 12 months after surgery (range, 12-24 months).
All patients underwent preoperative rehabilitation, with different criteria. Six of them did not improve with
non-surgical therapy while the rest worsened when therapy was discontinued [Table 1].

After LVA, all patients reported a subjective decrease in weight and/or firmness of the limb, and an
improvement in their quality of life, with a mean increase in overall satisfaction of 4.3 points in a 20-point
survey. The improvement in “satisfaction with limb appearance” was the most significant. All patients
responded “yes” to the question “Would you undergo surgery again?” after completing sequential therapy
(LVA and rehabilitation).

No severe postoperative complications have been reported to date. Four patients had frequent episodes of
cellulitis preoperatively that required hospital admission (three per year or more). None of them have had
repeated limb infection except an obese woman with lower limb lymphedema who smoked and did not
follow postoperative recommendations.

With respect to volume decrease, the circumference measurements reached near-normal values (less than
6 cm difference) in 15 patients [Table 2].