OBJECTIVE: To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

No abstract available.
Adult ; Arteriovenous Shunt, Surgical/*adverse effects ; Female ; Humans ; Ischemia/diagnosis/*etiology/surgery ; Ligation ; Peripheral Nervous System Diseases/diagnosis/*etiology/surgery ; *Renal Dialysis ; Reoperation ; Treatment Outcome ; Upper Extremity/*blood supply

OBJECTIVETo investigate the feasibility of free descending genicular artery perforator flaps in the soft tissue defects at extremities.

METHODSTen fresh cadavers were injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized volume-rendering software ( Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the perforators in the thigh and leg region were observed. 11 patients with skin defects at the distal part of extremities were treated. The flap size ranged from 5 cm x 8 cm to 6 cm x 15 cm. Six flaps were pedicled with the descending genicular artery and the others were pedicled with the perforator of the descending genicular artery. All flaps were transferred by end to end anastomosis. RESULTS The follow-up period ranged from 6 to 18 months. All the flaps survived. The appearance and texture of the flaps were good with sensory recovery of S3.

CONCLUSIONSFree descending genicular artery perforator flap has a reliable blood supply and suitable thickness for the treatment of soft tissue defects at extremities. The technique is easily performed with reliable results.

Arteries ; Cadaver ; Extremities ; injuries ; Feasibility Studies ; Follow-Up Studies ; Humans ; Leg ; Perforator Flap ; blood supply ; transplantation ; Soft Tissue Injuries ; surgery ; Thigh ; Upper Extremity

OBJECTIVETo investigate the feasibility and therapeutic effect of lateral thoracic flaps pedicled with subscapular vessels for defects in the upper extremities.

METHODSFrom June 2003 to September 2009, 5 cases with large soft tissue defects in the upper extremities were treated with lateral thoracic flaps pedicled with subscapular vessels. The flap size ranged from 23 cm x 8 cm to 40 cm x 20 cm. The subscapular vessels, the thoracodorsal vessels, the lateral branch and the cutaneous perforators of thoracodorsal vessels were all included in the flap. A muscular sleeve of 2-3 cm in width was preserved to protect the musculocutaneous perforator. The defects in the donor area were closed directly or covered by skin graft.

RESULTSThe lateral thoracic flaps were used in four cases. A combination of lateral thoracic flap and paraumbilical flap was used in one case. Partial necrosis happened at the distal portion of the flap in one case. All the other flaps survived completely. 4 cases were followed up for two to fourteen months with satisfactory cosmetic and functional results. The color, texture and thickness of the flaps were also satisfactory.

CONCLUSIONSThe lateral thoracic flap pedicled with the subscapular vessel is flexible for repairing defects in the upper extremities with a reliable blood supply, leaving less morbidity to donor site.

Adolescent ; Adult ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Upper Extremity ; injuries ; surgery ; Young Adult

OBJECTIVETo summarize clinical application result of the thoracodorsal artery perforator pedicled flap for repair of soft tissue defects on the ipsilateral upper limb.

METHODSFrom September 2003 to May 2007, 8 patients (6 males and 2 females) with soft tissue defects on the ipsilateral upper limb underwent reconstruction with the thoracodorsal artery perforator pedicled flap. The age of patients was from 16- to 45-years-old with an average of 32 years. Of them, the recipient sites of 5 cases were located on the arm region, 3 cases on the forearm.

RESULTSThe minor superficial infection of 1 case occurred on the recipient site after operation and the wound gradually healed by daily change dressings. All the flaps had survived completely and the postoperative course was uneventful with satisfactory clinical results. Follow-up period ranged for 9-38 months after operation (mean, 19 months). There was no remarkable donor site morbidity. All cases had good appearance on recipient site.

CONCLUSIONThe thoracodorsal artery perforator pedicled flap is thin and suitable for repair of soft tissue defect on the ipsilateral upper limb.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; physiopathology ; surgery ; Surgical Flaps ; blood supply ; Thoracic Arteries ; surgery ; Upper Extremity ; blood supply ; surgery ; Young Adult

INTRODUCTIONThis paper reviews the epidemiology, aetiology and management of upper limb ischaemia in a series of 8 patients presenting to a tertiary referral centre over a 4-year period and the review of the pertinent literature.

MATERIALS AND METHODSDetails of patients admitted to Tan Tock Seng Hospital (TTSH) due to critical ischaemia of the upper limbs were obtained from admission summaries through the Computerised Patient Support System (CPSS) and operative notes through LOTUS.

RESULTSThere were 8 patients who presented with upper limb ischaemia excluding trauma and iatrogenic causes over the last 4 years. All patients underwent embolectomy. One patient had an amputation post-embolectomy. Our short-term results were encouraging with 7 patients who were well enough to be discharged. One patient had a massive brainstem stroke and was discharged home for comfort care at the request of the family.

CONCLUSIONCareful physical examination and history taking, prompt recognition of upper limb ischaemia and active approach to management in the form of embolectomy are crucial in obtaining a good outcome and reducing the risk of late disabling effects.

Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Catheterization ; Coronary Angiography ; Embolectomy ; instrumentation ; Female ; Humans ; Ischemia ; diagnosis ; epidemiology ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Treatment Outcome ; Upper Extremity ; blood supply

OBJECTIVETo describe an operative method for the repair of electric burn wound in the upper limbs with lateral intercostal perforator-based pedicled flap, and to observe its clinical effect.

METHODSIntercostal artery perforator-based pedicled abdominal flap with the blood supply originating from the lateral perforator branches of the 7th-10th intercostal arteries were used to repair the wounds of 6 patients with burn wounds in elbows, forearm, wrists and palms. The pedicles were (16. 0 cm x 12. 0 cm) - (9. 0 cm x 7.0 cm) in area, and the pedicles were severed 18 to 21 days after the operation. The survival and the appearance of the flaps were observed after operation.

RESULTSThe procedure was easy and safe, and there was reliable and adequate blood supply in the lateral intercostal perforator-based pedicled flap. All the flaps survived in 5 patients, except marginal necrosis (3.5 cm x 2. 0 cm) was found in the distal portion of flap because flap cutting exceeded the paraumbilical line. The appearance was satisfactory after operation.

CONCLUSIONThis flap is suitable for the repair of deep wounds in hands, forearms, and elbows.

Adolescent ; Adult ; Aged ; Arm Injuries ; surgery ; Burns, Electric ; surgery ; Child ; Hand Injuries ; surgery ; Humans ; Intercostal Muscles ; blood supply ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Thoracic Arteries ; transplantation ; Upper Extremity ; injuries ; Young Adult

OBJECTIVETo search for the morphological evidence of five-shu-point so as to explain the theory of the five-shu-point more reasonably.

METHODSCarefully study on Yellow Emperor's Internal Classic and compare with the modern anatomic knowledge.

CONCLUSIONThe theory of five-shu-point is closely related with the theory of blood vessels. The distributional pattern of the superficial vein on the remote parts of the limbs (below the elbow or the knee joints) is the morphological basis for the theory of five-shu-point.

Acupuncture Points ; Humans ; Lower Extremity ; blood supply ; Medicine, Chinese Traditional ; Upper Extremity ; blood supply ; Veins ; anatomy & histology

OBJECTIVETo study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity.

METHODSBalloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity.

RESULTSBoth the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively.

CONCLUSIONSEmbolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.

Acute Disease ; Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Embolism ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Upper Extremity ; blood supply