Postoperative lymphedema of the upper limbs after breast cancer surgery is caused by the massive destruction of lymphatic vessels and the absence of lymph nodes due to external factors such as radical tumor surgery, radiation and chemotherapy, which obstructs lymphatic circulation and leads to lymphatic reflux obstruction and tissue edema. The incidence of this disease is increasing year by year, ranging from 6% to 14%, and it is a common clinical disease that is difficult to be cured by current treatments.
Lymphedema of the upper extremities secondary to breast cancer can occur at an early or late stage after surgery. After the first review of the oncology specialty, there is no abnormality, you can go to the corresponding lymphatic circulation disorder treatment specialty for consultation, education and treatment. Shanghai Ninth Hospital Plastic Surgery – Lymphatic Surgery Specialty Group was founded by Zhang Jiesheng, a famous academician in plastic surgery in China, who started to carry out animal experiments and clinical treatment of microscopic lymphatic surgery to reconstruct lymphatic vascular pathways with successful experience in China in the 1960s. It has outstanding achievements in clinical treatment of lymphedema as well as basic research on its etiology. Combined with the conservative treatment of lymphedema, we have now become one of the largest centers for the diagnosis and treatment of lymphatic circulation disorders in China and Asia.
At present, conservative treatment mainly carries out baking treatment, massage, pressure and microwave; surgical treatment advocates strictly selecting indications for lymphatic circuit function reconstruction surgery; it is especially important for patients to receive good disease health education and self-care. The above three procedures should be taken into account to clarify the pathogenesis of the disease, and comprehensive and orderly treatment can control its development in order to achieve a cure.
Disease example
Medical history: Ms. Zhang, a 46-year-old woman from Jiangsu, had radical surgery for right breast cancer 6 years ago and underwent radiochemotherapy. Although the tumor has been cured, swelling appeared in her left arm 3 years ago, which was not found in the vascular examination done in the hospital and gradually worsened, and there were two episodes of cutaneous dermatosis. The lymphedema continued to worsen, leading to recurrent episodes of lymphangitis, cellulitis, swelling and deformation of the limb and functional impairment, which seriously affected the patient’s quality of life.
Diagnosis: left upper limb lymphedema secondary to radical tumor surgery
Treatment.
1.Patient education.
2.Tumor reexamination.
3.Checking the degree of lymphatic vessel obstruction (MR lymphangiography).
4. baking and tying treatment to reduce upper limb edema and the onset of dermatitis.
5.Later elastic dressing plus self-skin care.
6.Dietary control.
7, combined with lymphatic access reconstruction treatment.
8.Later rehab treatment (self-manipulation lymphatic drainage).
Healing: good
Satisfaction: 95%
Microscopic lymph node-lymphatic vessel transplantation for obstructive lymphedema
Becker et al. used microsurgical techniques to transplant lymph nodes from the inguinal region to the axilla and confirmed that the transplanted lymph nodes functioned normally and were able to relieve and cure lymphedema. The transplanted lymph nodes were found to be functioning properly and were able to relieve and cure lymphedema. Lymph nodes are an important part of the lymphatic circulation pathway, and clinical studies have shown that the number of lymph node dissection or pathological biopsy of tumors is directly proportional to the incidence of lymphedema, thus highlighting the importance of lymph nodes in the lymphatic circulation pathway. Our group, especially Dr. Chaohua Jiang, has made new progress in microscopic lymph node-lymphatic vessel reconstruction for upper limb obstructive lymphedema based on traditional surgical treatment since his return to the United States. We found that there is a new theoretical basis for the treatment, and its treatment prospect is worth looking forward to.