Radical Resection with Preservation of Perforators for the Treatment of Advanced Upper Limb Lymphedema-Case Report

穿通枝保留的皮下組織切除法治療重度上肢淋巴水腫－病例報告

蔡穎瀚(Ying-Han Tsai) ； 馮冠明(Guan-Ming Feng) ； 姚勝發(Sheng-Fa Yao) ； 劉奕添(Yi-Tien Liu) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 20卷3期 (2011/09) Pp. 217-223

https://doi.org/10.7096/TJTSPS.201109.0217

摘要

背景：上肢淋巴水腫是乳癌術後可怕的併發症，它最好的處理方式是早期的保守性治療。對於那些中度至重度上肢淋巴水腫的病人，疾病會持續進展使患肢的重量加重。這使得病患體力逐漸衰弱，進而日常活動不便，所以需要手術的幫助。目標及目的：我們運用一種改良性的切除技術來治療上肢的淋巴水腫；它是利用顯微血管穿通枝及雙蒂皮瓣的概念來治療上肢的淋巴水腫。它可以一次手術達到功能及外觀上的滿意，不會有皮膚質地的問題，不會產生結笳，而且是長期來說有效的方法之一。材料及方法：我們在此提出一個接受改良性切除技術來治療上肢淋巴水腫的病例報告。術後利用彈性衣來重塑上肢外形，以及避免疤痕攣縮。而且術後追蹤測量上肢的手圍大小是判斷有無復發最客觀的證據。結果：我們利用這種改良性的切除手術達到立即腫塊消除的結果，使患肢減輕、在半年內恢復活動正常活動。病患在門診追蹤了三年，並無手圍增加或復發的跡象，這手術可以明顯地恢復患肢正常功能來改善病人的生活品質。結論：根據我們的經驗，上肢淋巴水腫的病人接受這種改良性的切除手術有最持久的改善程度。對於上肢的功能及外觀形狀有明顯的改善，並且減少反覆發炎的機率。

並列摘要

Background:Upper limb lymphedema is a dreaded complication of breast cancer treatment that is best managed by early conservative treatment. In moderate to severe upper limb lymphedema, the disease is so progressive that makes the weight of the affected limb increase. This debilitates the patient and impairs their daily activities, so surgical intervention should be entertained.Aim and Objectives:We emplyed a modified excisional method to treat upper limb lymphedema. It applies the microvascular perforator and bipedicle flap concepts to the treatment of lymphedema in the upper extremities. It can result in a functionally and aesthetically satisfactory one-stage operation but does not address problems of skin texture and scarring. It is one of the most helpful methods in the long term.Materials and Methods:There case report demonstrated the use of the modified excisional method to treat upper limb lymphedema. Pressure garments were used post-operatively to remodel the shape of upper limb and prevent scar contracture. Follow up was measured objectively by sequential measurements of the circumference in the upper limb.Results:We applied this modified excisional method to treat upper limb lymphedema. It results in an immediate and substantial volume reduction. The affected limb was lighter and normal daily activities were returned in 6 months. The patient was followed up in our OPD for 3 years. There were no signs of recurrence or increase in the circumference of the affected limb. It can significantly improve the patient's quality of life by restoring an incapacitated limb to functionality.Conclusion:Based on our experience, patients with upper limb lymphedema treated with this modified excisional method have long-lasting improvements. There was significant improvement of function and contour, as well as the decreased incidence of recurrent infections.

並列關鍵字

lymphedema ； upper limb ； staged excisions of subcutaneous tissue ； liposuction