Floor plan - 2013 Annual Meeting - American Association for Hand ...

Vascularized Groin Lymph Node Transfer for Postmastectomy Upper Extremity Lymphedema
Institution where the work was prepared: Cheng-Hung Lin, Taipei, Taiwan
Cheng-Hung Lin1; Rozina Ali1; Chris Wallace1; Hung-Chi Chen2; Ming-Huei Cheng1; (1)Chang Gung Memorial
Hospital, Chang Gung University, (2)E-Da Hospital, I-Shou University
OBJECTIVE:
The objective of this study was to evaluate the outcome of vascularized groin lymph node (VGLN) transfer in patients with postmastectomy
upper extremity lymphedema (PMUEL).
SUMMARY BACKGROUND DATA:
Microlymphatic surgery for obstructive lymphedema was introduced in 1977. Based on results observed in an experimental canine
model, VGLN transfer has been performed in place of microlymphatic surgery in our hospital as the first-line treatment for PMUEL
refractory to non-operative therapies. This shift has been fueled by the drive for less technically demanding and more physiological procedures.
METHODS:
Between January 1997 and June 2005, 13 consecutive patients with refractory PMUEL underwent VGLN transfer. Superficial inguinal
nodes supplied by the superficial circumflex iliac vessels, were harvested within a lympho-cutaneous flap measuring 10 cm by 5 cm and
transferred to the dorsal wrist of the lymphedematous limb. The superficial branch of the radial artery at the anatomical snuffbox and
the cephalic vein were used as recipient vessels. Outcome was assessed by reduction in upper limb girth, increased functional usage,
decrease in infection rate and improved lymphatic drainage on lymphoscintigraphy.
RESULTS:
All flaps survived although one flap required early re-exploration. No donor site morbidity was encountered. A postoperative reduction
in arm circumference was documented in eleven (84.6%) patients, with a mean percentage reduction in arm circumference of 53.2%. A
marked postoperative reduction in the incidence of cellulitis was noted in eleven patients. Postoperative technetium-labeled sulfur colloid
lymphoscintigraphy indicated improved lymph drainage of the affected arm, revealing decreased lymph stasis and more rapid lymphatic
clearance.
CONCLUSION:
VGLN transfer is a technically simple, reliable and safe procedure that significantly improves refractory PMUEL as assessed by objective
measures and clinical parameters.
Use of Nerve Conduits as an Adjunct to Brachial Plexus Micro-Neurorraphy
Institution where the work was prepared: Hospital for Special Surgery, New York, NY, USA
Helene L. Strauss, BA1; Richard Cheng, BS2; Scott Wolfe, MD3; Joseph Feinberg, MD3; (1)UMDNJ, (2)Dartmouth
Medical School, (3)Hospital for Special Surgery
HYPOTHESIS:
The use of nerve conduits in level I clinical trials shows improvement in sensory recovery when compared with direct repair. While primate
studies on major mixed motor-sensory nerves have also documented significant improvements over direct repair with nerve conduits,
no clinical data analyzing motor recovery following nerve conduit repair has been reported. We hypothesize that the recovery of
nerves repaired with conduits surpasses that of nerves repaired with end-to-end neurorraphy.
METHODS:
17 patients had one or multiple nerve-to-nerve transfers for adult traumatic brachial plexus palsy using the operative microscope, with
some patients undergoing multiple procedures. 7 transfers were performed by advancing the nerve ends into a semi-permeable Type I
cross-linked collagen conduit and 24 nerve transfers were performed utilizing standard end-to-end neurorraphy. No repairs involved interposition
grafts. Postoperative rehabilitation and follow-up were identical between groups. The following three criteria were analyzed: clinical
evaluation using the Medical Research Council grading scheme of muscle function at one year, at two years, and postoperative EMG.
31 and 21 transfers were available for one- and two-year follow-up testing, respectively. Two-tailed unpaired t-tests were completed.
RESULTS/STATISTICS:
For all three evaluation criteria, no significant differences existed between the conduit and standard end-to-end neurorraphy. Notably,
all transfers performed with nerve conduits demonstrated clinical and electromyographic reinnervation at one year and all 6 muscles
with two year follow-up data demonstrated M3 or M4 clinical function.
CONCLUSION:
Functional muscle recovery is equivalent for nerve transfers performed with collagen nerve conduits and by traditional micro-neurroraphy.
Successful conduit usage for motor neuron repair in humans as documented here and previous studies of conduit usage in animals
and sensory neurons warrant continued investigation into conduit repair efficacy and potential improvements in operative time,
precision of repair, and speed of nerve recovery.
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