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Treatment of Truncal Lymphedema Using Lymphovenous Anastomoses and Recognition of Common Lymphatic Patterns

Shayan M Sarrami, MD Meti Mehta, BS Chanel Reid, MD Carolyn De La Cruz, MD
University of Pittsburgh
2025-01-10

Presenter: Shayan Sarrami

Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All work on this project represents the original work of the resident/ student/ faculty. I approve submission of this work.

Director Name: Vu Nguyen

Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction

Introduction
The use of lymphovenous anastomosis (LVA) to treat breast cancer related truncal lymphedema has not been well described. By analyzing the superficial lymphatic patterns of truncal lymphedema patients, we can identify common target locations for LVAs.

Methods
We reviewed breast cancer patients with truncal lymphedema who underwent fluorescent lymphography between December 2014 and January 2024. We assessed the direction of lymphatic drainage and dermal backflow patterns throughout the trunk. Dermal backflow severity in various regions of the trunk was compared using analysis of variance. We performed full case reviews of patients who received LVAs.

Results
Our cohort included 106 hemi-trunks (85 patients). Lymphatic drainage to the ipsilateral axilla was seen in 39%, while 61% had drainage to the ipsilateral groin, and 25% had contralateral drainage. Dermal backflow was significantly worse in the superior trunk (p<0.001). 84% of the mastectomy skin flaps had diffuse or absent lymphatic channels. Two patients underwent microsurgical treatment. Location of each LVA was plotted around regions of most severe lymphedema and based on direction of lymphatic drainage. Using florescent lymphography to identify patent lymphatic channels and ultrasound to identify nearby veins, two LVAs were performed per patient in the lateral chest, inferior to the IMF. The orientation of each anastomosis supported drainage from the mastectomy flaps to the ipsilateral inguinal lymph nodes. Both patients reported immediate reduction in swelling and symptoms.

Conclusion
Gaining an improved understanding for patterns of lymphatic disruption and drainage in the trunk has been critical to our reconstructive microsurgery success.

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