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Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats
Author(s) -
Nguyen Dung H.,
Chou PanYu,
Hsieh YuHsuan,
Momeni Arash,
Fang YuHua Dean,
Patel Ketan M.,
Yang ChinYu,
Cheng MingHuei
Publication year - 2016
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22388
Subject(s) - medicine , lymphedema , groin , lymph , hindlimb , lymphatic system , surgery , lymph node , reduction (mathematics) , anatomy , urology , pathology , cancer , breast cancer , geometry , mathematics
Purpose This study was conducted to investigate the correlation between the number of vascularized lymph nodes (LN) transferred and resolution of hind limb lymphedema in a rat model. Methods Unilateral hind limb lymphedema was created in 18 male Sprague–Dawley rats following inguinal and popliteal LN resection and radiation. A para‐aortic LN flap based on the celiac artery was subsequently transferred to the affected groin. The three study groups consisted of Group A (no LN transfer), Group B (transfer of a single vascularized LN), and Group C (transfer of three vascularized LNs). Volumetric analysis of bilateral hind limbs was performed using micro‐CT imaging at 1, 2, and 3 months postoperatively. Lymphatic drainage was assessed with Tc 99 lymphoscintigraphy preoperatively and at 3 months postoperatively. Results A statistically significant volume reduction was seen in Groups B and C compared to Group A at all time points. Volume reduction of Group A vs.Group B at 1 month (8.6% ± 2.0% vs. 2.7% ± 2.6%, P < 0.05), 2 months (9.3% ± 2.2% vs. −4.3% ± 2.7%, P < 0.05), and 3 months (7.6% ± 3.3% vs. −8.9% ± 5.2%, P < 0.05). Volume reduction of Group A vs. Group C at 1 month (8.6% ± 2.0% vs. −6.6% ± 3.1%, P < 0.05), 2 months (9.3% ± 2.2% vs. −10.2% ± 4.6%, P < 0.05), and 3 months (7.6% ± 3.3% vs. −9.1% ± 3.1%, P < 0.05). Of note, comparison of Groups B and C demonstrated greater volume reduction in Group C at 1 ( P < 0.02) and 2 ( P = 0.07) months postoperatively. Conclusions LN flap transfer is an effective procedure for the treatment of lymphedema. The number of vascularized LNs transferred correlates positively with the degree of volume reduction. © 2015 Wiley Periodicals, Inc. Microsurgery 36:239–245, 2016.