Evaluation of the results of autologous lymph node transplantation in the management of lymphedema of the extremities / Mohamed Said Mohamed Ali Elkholy ; Supervised Ahmed Tarek Abdelhamid Atta , Tarek Ahmed Mohamed Ali Amer , Hamed Mohamed Kadry Mohamed Kadry

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of General Surgery

Lymphedema is a chronic, progressive disease caused by the accumulation of extra fluid and protein deposits. Lymph stasis induces an inflammatory reaction, proliferation of adipose tissue and fibrosis. It is either due to genetic or develop-mental causes (primary lymphedema), or as a result of insult such as trauma, or infection (secondary lymphedema).Lymphedema is initially managed by decongestive physiotherapy. Free lymph node transfer has been the most recent development in the treatment of lymphedema.In this study, during the period between October 2014 and April 2017, a total of 14 patients with 15 limbs were included. Thoracodorsal lymph nodes group was used in 2 cases and inserted in groin region. The submandibular lymph node was the donor site in 13 cases and inserted at midleg (1 case) and at distal sites (ankle or wrist) in 12 cases.The results showed: The mean value of percentage of edema reduction 71.6% ± 0.48%, (P {u2264}0.001).The frequency of attacks of cellulitis markedly decreased from 6.8000 ± 5.17135 pre-operative to 0.4667 ± 0.74322 post-operative (P value {u2264} 0.001).Also the need for pressure garments decreased by the end of the first year to 80% and reached 93.3% by the end of second year. Magnetic resonant lymphangiography showed marked decrease in dilated tortuous lymphatics and improvement in dermal back flow (100% of patients), new lymphatics around site of anastomosis with filling of surrounding deep veins denoting a good lympho-venous shunt (100% of patients), visualization of newly transferred lymph node seen in (26.6% of patients)

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