Histopathological Changes In The Skin And Subcutaneous Tissue After Free Lymph Node Transplantation In Lymphedematous Limbs

Lymphedema remains a challenging problem. Reconstructive microsurgery operations are considered for those patients with proximal obstruction of the extremity lymphatic circulation with preserved, dilated lymphatics distal to the obstruction. However, for those patients with hypoplastic or fibrotic distal lymphatic vessels, such reconstructions are not an option. We performed this preliminary study to assess the microsurgical lymph node transplantation as a treatment in lymphedematous .Methods: Since june 2006 till july 2010 , 30 patients with limb lymphoedema were treated with free lymph node transplantation with rigid program of conservative therapy before and after surgical intervention. According to preoperative lymphoscintigraphy and aetiolgy and extent of lymphoedema clinically , the choice of flap and recipient areas were judged. Lymph node flaps were harvested either in the groin or axillary regions, transferred to the recipient areas, and transplanted by microsurgical procedures. Postoperative evaluation of the results depends on clinical evaluation of limbs including quality of skin and rate of infectious episodes , need for conservative measures , and periodic limb measurements. In addition , lymphoscintigraphic and histopathological studies were performed one year after surgery.Results: After surgery, all patients felt alleviation of symptoms caused by lymphoedema. Postoperative Isotopic Lymphoscintigraphy showed the isotopic capture in the transplanted lymph nodes in 3 cases (10%) . The non-pitting skin of the limbs at surgery side gets soft in 10 patients (33%) at one year postoperatively. Erysipelas did not recur within one year after surgery in 20 patients (66%). The RLC was highly statistically significant (p < 0.001). The replacement of thick collagen bundles around adnexi in the first intraoperative specimen with adipose cells in the postoperative specimen was the remarkable finding noted in the subcutaneous tissue.Conclusion: Over the last 5 years, our team has treated limb lymphoedema by transplanting lymph nodes flaps. It is a safe procedure permitting improvement, in lymphoedema, especially in the early stages of the disease with secondary lymphedema. It is now time to perfect the technique in order to provide longlasting and consistent achievement of good outcomes in every one of the patients.Keywords: Lymphedema ; flap ; histopathology ; lymph node ; transplantation.