Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study
Aim: Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial cell migration toward the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aimed to examine the hypothesis that nanofibrillar collagen scaffolds (NCS)...
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Elsevier
2025-03-01
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| author | Dimitrios Dionyssiou Antonios Tsimponis Eleni Georgiadou Konstantina Mamaligka Efterpi Demiri |
| author_facet | Dimitrios Dionyssiou Antonios Tsimponis Eleni Georgiadou Konstantina Mamaligka Efterpi Demiri |
| author_sort | Dimitrios Dionyssiou |
| collection | DOAJ |
| description | Aim: Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial cell migration toward the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aimed to examine the hypothesis that nanofibrillar collagen scaffolds (NCS) combined with VLNT can provide guided lymphagiogenesis creating long-lasting lymphatic pathways. Methods: Twenty-four patients (21 female, 3 male) underwent a lymphatic microsurgery for upper (n = 11) or lower (n = 13) limb secondary lymphedema and completed at least 18 months follow-up were selected and equally divided in 2 groups; Group-A underwent VLNT, Group-B underwent combined VLNT and NCS procedure. Lymph node flap sizes, harvesting procedure, and implantation location were similar in both groups. Demographics, lymphedema etiology and staging, limb volumetry, and somatometric data were recorded. Pre- and post-operative data for limb-volume difference, infection episodes/year, and indocyanine-green (ICG) lymphography changes were documented in all patients. Results: Mean follow-up was period was 42 months (24–60 months) in Group-A, and 27 months (18–48 months) in Group-B patients. Demographic data, lymphedema etiology, and staging were comparable in both groups. Pre- and post-operative edema volume difference for Group-A was 36 % and 25 % (p < 0.001), and 33 % and 14 % in Group-B (p = 0.001), respectively. The mean number of infection episodes decreased in Group-A and B from 1.75 to 0.33 and from 2.17 to 0.42 per patient/year, respectively. ICG mean stage in Group-A was 3.58 pre- and 3 post-operatively (p = 0.045), and 3.67 pre- and 2.08 post-operatively in Group-B (p = 0.506). A statistically significant difference was found in post-operative volume difference between the 2 groups (p = 0.008) and post-operative ICG changes (p < 0.001). ICG-lymphography demonstrated new lymphatic vessel formation at the NCS implantation location. Conclusions: Long-term follow-up of the patients treated using combined VLNT-NCS approach revealed a statistically significant improvement regarding volume reduction, infection episodes per year, ICG downstaging, and new lymphatic vessel formation, compared to VLNT alone. |
| format | Article |
| id | doaj-art-cdb4a0cd96134d13bffded346dfb66d6 |
| institution | DOAJ |
| issn | 2352-5878 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-cdb4a0cd96134d13bffded346dfb66d62025-08-20T02:46:59ZengElsevierJPRAS Open2352-58782025-03-014332833910.1016/j.jpra.2024.11.019Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational StudyDimitrios Dionyssiou0Antonios Tsimponis1Eleni Georgiadou2Konstantina Mamaligka3Efterpi Demiri4Corresponding author.; Department of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, GreeceDepartment of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, GreeceDepartment of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, GreeceDepartment of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, GreeceDepartment of Plastic Surgery, Aristotle University of Thessaloniki, School of Medicine, Papageorgiou General Hospital, Thessaloniki, 54603, GreeceAim: Vascularized lymph node transfer (VLNT) accelerates growth factor secretion, lymphatic endothelial cell migration toward the interstitial flow and lymphagiogenesis in a multidirectional pattern. Our observational study aimed to examine the hypothesis that nanofibrillar collagen scaffolds (NCS) combined with VLNT can provide guided lymphagiogenesis creating long-lasting lymphatic pathways. Methods: Twenty-four patients (21 female, 3 male) underwent a lymphatic microsurgery for upper (n = 11) or lower (n = 13) limb secondary lymphedema and completed at least 18 months follow-up were selected and equally divided in 2 groups; Group-A underwent VLNT, Group-B underwent combined VLNT and NCS procedure. Lymph node flap sizes, harvesting procedure, and implantation location were similar in both groups. Demographics, lymphedema etiology and staging, limb volumetry, and somatometric data were recorded. Pre- and post-operative data for limb-volume difference, infection episodes/year, and indocyanine-green (ICG) lymphography changes were documented in all patients. Results: Mean follow-up was period was 42 months (24–60 months) in Group-A, and 27 months (18–48 months) in Group-B patients. Demographic data, lymphedema etiology, and staging were comparable in both groups. Pre- and post-operative edema volume difference for Group-A was 36 % and 25 % (p < 0.001), and 33 % and 14 % in Group-B (p = 0.001), respectively. The mean number of infection episodes decreased in Group-A and B from 1.75 to 0.33 and from 2.17 to 0.42 per patient/year, respectively. ICG mean stage in Group-A was 3.58 pre- and 3 post-operatively (p = 0.045), and 3.67 pre- and 2.08 post-operatively in Group-B (p = 0.506). A statistically significant difference was found in post-operative volume difference between the 2 groups (p = 0.008) and post-operative ICG changes (p < 0.001). ICG-lymphography demonstrated new lymphatic vessel formation at the NCS implantation location. Conclusions: Long-term follow-up of the patients treated using combined VLNT-NCS approach revealed a statistically significant improvement regarding volume reduction, infection episodes per year, ICG downstaging, and new lymphatic vessel formation, compared to VLNT alone.http://www.sciencedirect.com/science/article/pii/S2352587824001888Lymphedema microsurgical treatmentLymph node transferCollagen scaffoldsLymphagiogenesis |
| spellingShingle | Dimitrios Dionyssiou Antonios Tsimponis Eleni Georgiadou Konstantina Mamaligka Efterpi Demiri Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study JPRAS Open Lymphedema microsurgical treatment Lymph node transfer Collagen scaffolds Lymphagiogenesis |
| title | Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study |
| title_full | Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study |
| title_fullStr | Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study |
| title_full_unstemmed | Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study |
| title_short | Long-term results of lymphedema treatment with Combined lymph node transfer and collagen scaffolds: An Observational Study |
| title_sort | long term results of lymphedema treatment with combined lymph node transfer and collagen scaffolds an observational study |
| topic | Lymphedema microsurgical treatment Lymph node transfer Collagen scaffolds Lymphagiogenesis |
| url | http://www.sciencedirect.com/science/article/pii/S2352587824001888 |
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