Background: Vascularized lymph node transfer (VLNT) has proven to be a valuable treatment for patients affected by advanced stages of lymphedema. Although a spontaneous neo-lymphangiogenesis has been advocated to explain the positive effects of VLNT, there is still a lack of supportive biological evidence. The aim of the paper was to demonstrate the post-operative formation of new lymphatic vessels using histological skin sections from the lymphedematous limb. Materials and methods: All patients diagnosed with extremities' lymphedema who had undergone gastroepiploic vascularized lymph node flap (GE-VLN) between January 2016 and December 2018 were identified. Full thickness 6-mm skin punch biopsies were obtained from all voluntary patients at identical sites of the lymphedematous limb (during the surgical procedure of VLNT (T0) and 1 year later (T1). The histological samples were prepared to be immunostained with Anti-Podoplanin / gp36 antibody. Results: The study analyzed the results of 14 lymph node transfer voluntary patients. At 12 months of follow-up, the mean circumference reduction rate was 44.3 ± 4.4 at above elbow/above knee level (AE/AK) and 60.9 ± 7 at below elbow/below knee level (BE/BK) Podoplanin expression values were on average 7.92 ± 1.77 (vessels/mm2) at time 0 and 11.79 ± 3.38 (vessels/mm2) at T1. The difference was statistically significant between pre-operative and post-operative values (p=0.0008). Conclusion: The present study provides anatomic evidence that a neo-lymphangiogenetic process is induced by the VLNT procedure as new functional lymphatic vessels can be detected in close proximity to the transferred lymph nodes.
LYMPH NODE TRANSFER AND NEO-LYMPHANGIOGENESIS. FROM THEORY TO EVIDENCE
Maruccia, Michele;Giudice, Giuseppe;Cazzato, Gerardo;Elia, Rossella
2023-01-01
Abstract
Background: Vascularized lymph node transfer (VLNT) has proven to be a valuable treatment for patients affected by advanced stages of lymphedema. Although a spontaneous neo-lymphangiogenesis has been advocated to explain the positive effects of VLNT, there is still a lack of supportive biological evidence. The aim of the paper was to demonstrate the post-operative formation of new lymphatic vessels using histological skin sections from the lymphedematous limb. Materials and methods: All patients diagnosed with extremities' lymphedema who had undergone gastroepiploic vascularized lymph node flap (GE-VLN) between January 2016 and December 2018 were identified. Full thickness 6-mm skin punch biopsies were obtained from all voluntary patients at identical sites of the lymphedematous limb (during the surgical procedure of VLNT (T0) and 1 year later (T1). The histological samples were prepared to be immunostained with Anti-Podoplanin / gp36 antibody. Results: The study analyzed the results of 14 lymph node transfer voluntary patients. At 12 months of follow-up, the mean circumference reduction rate was 44.3 ± 4.4 at above elbow/above knee level (AE/AK) and 60.9 ± 7 at below elbow/below knee level (BE/BK) Podoplanin expression values were on average 7.92 ± 1.77 (vessels/mm2) at time 0 and 11.79 ± 3.38 (vessels/mm2) at T1. The difference was statistically significant between pre-operative and post-operative values (p=0.0008). Conclusion: The present study provides anatomic evidence that a neo-lymphangiogenetic process is induced by the VLNT procedure as new functional lymphatic vessels can be detected in close proximity to the transferred lymph nodes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.