Background:With respect to survival and local disease control, the adequate extent of lymph node dissection for melanoma metastasis to the groin is controversial. Since the methods for accurate quantification of leg oedemas are not well standardised, it remains also unclear whether the iliac part of a radical ilioinguinal lymph node dissection contributes to postoperative lymphoedema.
Patients and Methods: Using a questionnaire and clinical examinations, we prospectively studied 65 persons for the presence of leg swellings (11 with inguinal lymph node dissection (sCLND), 23 with ilioinguinal dissection (rCLND), and 31 without nodal surgery and without signs of venous insufficiency). Exact volumetry of the legs was performed using the Image 3 D method.
Results: The mean interval between the lymphadenectomy and the examination for swellings was 24 ± 30 months. Compared with sCLND, the amount of postoperative drainage fluid was significantly higher after rCLND (1960 ± 1390 mL versus (vs.) 898 ± 578 mL). Patients with rCLND perceived more frequently leg swellings (83 % vs. 55 %, p = 0.09), however, also 23 % of the control persons perceived leg swellings. Clinical signs of swelling were found slightly more frequently in the rCLND group (52 % vs. 45 %). After rCLND, the gain in volume of the ipsilateral thigh was significantly higher than after sCLND (7.01 ± 4.83 % vs. 1.29 ± 6.12 %, p = 0.01). Patients with rCLND more frequently needed manual lymph drainage (70 % vs. 45 %). In the control persons, the volumes of the right (mostly dominant) and the left legs did not differ significantly.
Conclusions:Our results suggest that the iliac part of an ilioinguinal lymph node dissection significantly contributes to lymphoedema. Because of the multitude of reasons for swellings of the lower leg, volumetry of the thigh seems to be most adequate for quantifying the amount of postoperative lymphoedema.
Primary lymphedema complicated by weeping chylous vesicles in the leg and scrotum: report of a case.
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan, email@example.com.
We report a case of primary lymphedema complicated by leaking chylous vesicles in the toe and scrotum, caused by lymphangiectasia, which was eventually managed with lymphaticovenular anastomoses after conservative treatments proved ineffective. The patient was a 25-year-old man with a 5-year history of massive swelling with chylous weeping of his right legand scrotum. Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph reflux. Although he was instructed in standard methods of complex therapy, it did not alleviate his symptoms. Because of the increasing frequency of cellulitis, lymphatic surgery was finally indicated. The operation consisted of lymphaticovenous anastomoses (LVA) in the ankle and groin, using a super-micro-surgical technique. After surgery, his symptoms resolved and have been controlled by self-care. Thus, early LAS to confirm the dilated iliac lymph trunks causing lymph reflux, followed by LVA might be beneficial for the management of this disease.
Breast Care Department, Walter Reed National Military Medical Center, Bethesda, MD, USA2 Department of Dermatology, Medical University of Vienna, Vienna, Austria3 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary4 Lymphoedema Unit, University Hospital La Fe Valencia, Spain5 Barbantini-Hospital, Lucca, Italy6 Cardiac anc Vascular Sciences St George's, University of London, London, UK7 Department of Dermatology, University Hospital KU, Leuven, Belgium8 Department of Dermatology, Nij Smellinghe Hospital, Drachten, The Netherlands 9 Department of Surgery, School of Medicine, Flinders Medical Centre, Bedford Park, Australia10 Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA11 Hospital Begin, Paris, France12 Thames Valley University, London, UK13 Phlebology Department, Saint Antoine Hospital, Paris, France14 Lympho-Opt Clinic, Pommelsbrunn, Germany15 Wound Healing Research, Cardiff University, UK16 Boucicaut, Fontenay aux Roses, France.
Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy.
Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema.
An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema.
Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.