Secondary Logo

Journal Logo

Lymph Node Transplantation and Quantitative Clearance Lymphoscintigraphy

Singhal, Dhruv M.D.; Spiguel, Lisa M.D.; Shaw, Christiana M.D.; Sapountzis, Stamatis M.D.; Mast, Bruce M.D.; Chen, Hung-Chi M.D.; Drane, Walter M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 937e–939e
doi: 10.1097/PRS.0000000000001203
Viewpoints
Free

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida Health System, University of Florida Medical School, Gainesville, Fla.

Department of Surgery, Division of Surgical Oncology, University of Florida Health System, University of Florida Medical School, Gainseville, Fla.

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida Health System, University of Florida Medical School, Gainseville, Fla.

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

Department of Radiology, University of Florida Health System, University of Florida Medical School, Gainseville, Fla.

Correspondence to Dr. Singhal, Division of Plastic Surgery, University of Florida, 1600 Archer Road, P.O. Box 100138, Gainesville, Fla. 32610-0138, dhruv.singhal@surgery.ufl.edu

Back to Top | Article Outline

Sir:

Lymphedema remains a serious burden of disease, with physical therapy the primary readily available treatment option with limited success. Multiple surgical procedures aimed at improving the lymphatic physiology of affected extremities are being performed at many institutions worldwide. However, no ideal method of evaluating the severity of disease and results of these procedures has been agreed on.1 We offer the first report of quantitative clearance lymphoscintigraphy in the preoperative and postoperative evaluation of a lymph node transplantation.

A 61-year-old woman with an 8-year history of left upper extremity lymphedema following a left axillary dissection for breast cancer management presented to the University of Florida. The patient’s lymphedema was staged as a Hung-Chi Chen IIIb/Campisi III.2,3 Lymph node transplantation was performed based on the superficial circumflex iliac vessels in the right groin to the left wrist. Preoperative and postoperative quantitative clearance lymphoscintigraphy was performed using technetium-99m sulfur colloid (10 percent filtered, 1 μm; 90 percent unfiltered) injected into the first webspace. Twenty-four–hour clearance values were obtained after each injection.

Preoperative quantitative lymphoscintigraphy demonstrated 18 percent removal of colloid from the injection site at 24 hours with slow uptake at the supraclavicular nodes, no identifiable axillary lymph nodes, severe dermal backflow, and no hepatic clearance (Fig. 1). At 3-month follow-up, repeated injection at the same site 24 hours later revealed visualization of the transplanted nodes, 40 percent removal of colloid from the injection site, persistent slow uptake at the supraclavicular nodes, marked improvement in dermal backflow, and the presence of hepatic clearance (Fig. 2).

Fig. 1

Fig. 1

Fig. 2

Fig. 2

To adequately compare procedures and results, surgeons undertaking physiologic procedures for lymphedema must develop standardized techniques to accurately quantify levels of success or failure. Current methods of quantification such as circumferential measurements and volumetry are user dependent, thereby complicating our ability to compare results between patients, surgeons, and institutions. Although our experience is early, quantitative clearance lymphoscintigraphy appears to offer confirmation of lymph node viability, qualitative information regarding lymphatic flow patterns, and objective lymphatic clearance values.

Back to Top | Article Outline

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication.

Dhruv Singhal, M.D.

Department of Surgery

Division of Plastic and Reconstructive Surgery

University of Florida Health System

University of Florida Medical School

Gainesville, Fla.

Lisa Spiguel, M.D.

Christiana Shaw, M.D.

Department of Surgery

Division of Surgical Oncology

University of Florida Health System

University of Florida Medical School

Gainseville, Fla.

Stamatis Sapountzis, M.D.

Department of Plastic and Reconstructive Surgery

China Medical University Hospital

Taichung, Taiwan

Bruce Mast, M.D.

Department of Surgery

Division of Plastic and Reconstructive Surgery

University of Florida Health System

University of Florida Medical School

Gainseville, Fla.

Hung-Chi Chen, M.D.

Department of Plastic and Reconstructive Surgery

China Medical University Hospital

Taichung, Taiwan

Walter Drane, M.D.

Department of Radiology

University of Florida Health System

University of Florida Medical School

Gainseville, Fla.

Back to Top | Article Outline

REFERENCES

1. Suami H, Chang DW.. Overview of surgical treatments for breast cancer-related lymphedema. Plast Reconstr Surg. 2010;126:1853–1863
2. Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F.. Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery. 2001;21:135–139
3. Salgado CJ, Mardini S, Spanio S, Tang WR, Sassu P, Chen HC.. Radical reduction of lymphedema with preservation of perforators. Ann Plast Surg. 2007;59:173–179
Back to Top | Article Outline

GUIDELINES

Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

  • Text—maximum of 500 words (not including references)
  • References—maximum of five
  • Authors—no more than five
  • Figures/Tables—no more than two figures and/or one table

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2015American Society of Plastic Surgeons