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PERCUTANEOUS SCLEROTHERAPY OF LYMPHOCELE AND LYMPHORRHEA USING POVIDONE IODINE’S FOAM
AMER HAMADÉ, NAOUEL BENSALAH, HÉLÈNE LAMBACH, BASTIEN WOEHL, PIERRE MICHEL, GOLNAZ OBRINGER, MICHÈLE LEHN-HOGG, NATHALIE BUSCHENRIEDER
Vascular Medicine, GHR Mulhouse et Sud-Alsace, Hôpital Emile Muller, Mulhouse, France
Purpose: The Lymphoceles and Lymphorrhea can be treated by sclerotherapy: sclerosis using doxycline, sclerosis applying amidototrozoate, sclerosis using alcohol and povidone-iodone. Lymphorrhea and lymphocele are a possible complication after trauma, surgery and biopsy. Their treatment is considered to be as less traumatic as possible because it is intended for patients already operated. We propose the efficacy of the percutaneous sclerotherapy of lymphorrhea and lymphocele using povidone-iodine’s foam.
Materials and Methods: We studied 12 patients, 4 men and 8 women aged from 32 to 82 years who presented lymphatic complications, 4 patients with lymphatic fistula and lymphorrhea (LA), 8 with lymphocele (LE): 2 men presented LE after radical prostatectomy, 3 women LA after breast cancer surgery, 5 LE after vascular surgery and biopsy on the inguinal region, one LA on the thigh after melanoma surgery and one LE on the leg after vascular surgery. We have treated all the patients by local medical care, compressive dressing and percutaneous sclerotherapy using povidone-iodine’s foam. In deep lymphoceles an ulrasound’s guidance was necessary.
Results: The evolution was favorable with complete but late closure of the LA and LE. Multiple sclerosis were necessary to treat the patients. No major complication was reported.
Conclusion: In certain cases, the treatment of choice of the LA and LE would possibly be the percutaneaous sclerotherapy using povidone-iodine’s foam.
Keywords: Povidone iodine, slerotherapy.
LYMPHA TECHNIQUE IN PREVENTING BCRL: OUR SINGLE-INSTITUTION EXPERIENCE
BUSETTO A.1, DORRUCCI V.1, PAPACCIO G.2
1 Cardio-Thoracic and Vascular Surgery Department, Vascular Surgery Unit, “Dell’Angelo” General Hospital, Mestre-Venice, Italy 2 General Surgery Department, Breast Unit, “Dell’Angelo” General Hospital, Mestre-Venice, Italy
Purpose: the benefit of LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) technique to prevent BCRL (Breast Cancer Related Lymphedema), as described in previous works by Boccardo et al, is nowadays well assessed.
Straight candidates to LYMPHA technique are patients with high BMI (>30); those ones with normal BMI become candidates when latent lymphatic impairment is assessed by lymphoscintigraphy.
Starting from what already taken, we present our preliminary experience with this unique surgical procedure.
Methods: Between September 2015 to July 2016, 5 patients with breast cancer requiring axillary lymphadenectomy underwent BCRL prevention by LYMPHA technique (5,5% of all submitted to cancer resection and LA). Cases were selected by age (<65 years) and stage (clinic,hatic collectors, afferent to blue nodes, and collateral branches of axillary vein were performed.
Volumetry and lymphoscintigraphy were assessed pre and postoperatively in all patients; the latter after approximately 6 months, comparing pre and post-op lymph Transport Index (TI – normal below 10). Mean follow-up was 6 (6-15) months.
Results: Five patients received LYMPHA protocol. Four of them (80%) had no sign of lymphedema and volumetry was coincident to preoperative condition; lymphoscintigraphy showed MLVA patency at 6 months after operation and normalization of lymphatic TI, compared to preoperative conditions; no lymphocele or infectious complications occurred.
One patient (20%) developed a lymphangitic attack during RT, about 2 months postoperatively, with permanent arm lymphedema; lymphoscintigraphy displayed MLVA occlusion and TI over 20.
Conclusions: Even in our initial experience, learning curve well-thought-out, the LYMPHA technique appears feasible, safe and effective for BCRL prevention.
Keywords: LYMPHA technique, arm lymphedema, prevention, breast cancer, MLVA.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 76 - 2017