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Autologous lymph nodes transplantation: Utility of MRI as an objective tool for clinical assessment of patients with congenital lymphedema
Christine Fisher MD and Corinne Becker MD
Department of Plastic and Reconstructive Surgery.
University of Pittsburgh Medical Center, Pittsbu
2013-03-15
Presenter: Christine Fisher MD
Affidavit:
The majority of this research project reflects the work of the resident:
Director Name: J.E. Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Manual lymphatic drainage was the only method of management for chronic lymphedema for many decades, but only delays the progress of the disease during ongoing therapy. Surgical treatment, either for curative/reconstructive or for palliative/ excisional purposes, has been pursued as an alternative method of controlling chronic lymphedema. Based on extensive anatomical and experimental studies in both animal and human models, autologous lymph node transplantation is indicated for patients with both secondary and primary lymphedema. In the diagnosis and treatment of congenital lymphedema, lymphangioscintigraphy is suboptimal. Lymphatic magnetic resonance imaging (L-MRI) provides more useful information. Seventy patients with long-term follow up postoperative L-MRI scans demonstrate new lymphatic vessels sprouting from the transplanted nodes and a reduction of edema in the affected limb. Clinically; limb circumference was greatly improved and soft tissue infections were eliminated in the majority of patients. Nearly half of the patients were completely cured of edema, and discontinued ongoing physiotherapy. No patients edema worsened postoperatively. Magnetic resonance lymphangiography is a useful objective tool for assessment of patient improvement after autologous lymph node transfer for treatment of congenital lymphedema.
