Lymphedema Flashcards
What are the risk factor for secondary lymphedema?
obesity, infections, radiation, and genetic predisposition
What associated features that manifest in several primary lym phedema phenotypes and can influence natural history
associated features such as vascular anomalies and limb growth disturbances that manifest in several primary lym phedema phenotypes and can influence natural history
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema. Tor F
T
In radiological investigations for brachial pleaxus diaphragmatic muscle paralysis (hemidiaphragmatic elevation on the injured side) suggests a likely involvement of the lower plexus
diaphragmatic muscle paralysis (hemidiaphragmatic elevation on the injured side) suggests a likely involvement of the upper plexus as the diaphragmatic innervation (C3, C4, and CS) that is involved
Symprachoductyly most commonly is bilateral?
Synprachoductyly is more common in males, and is often unilateral, affecting the left extremity in two-thirds of cases
What is the most common type of polyductyly?
Postaxial polydactyly can present as a small skin nubbin on the ulnar aspect of the hand or as a fully formed digit This is the most common type of polydactyly and is frequently found in African Americans
Flexion contraction can occur in MCP andDIP in camptoductyly?
F. Only pip Although hyperextension of the DIP or MCP joints may occur in camptodactyly, flex.ion contracture of these joints would instead suggest a post-traumatic cause.
Camptoductyly can be associated with swan neck deformities?
boutonniere deformity.
When i should seek treatment for clinodactyly?
Treatment for clinodactyly is typically considered when there is more than 20 degrees of deviation
Lymphovenous anastomosis is indicated in any stages
Lymphovenous anastomosis is indicated in the early stages
what the percentage of congenital lymphoedeme?
Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases. Women are affected
twice as often as men, and the lower limb is involved three times as
commonly as the upper limb.
What the incidence of
lymphedema following lymph node biopsy?
sentinel lymph node biopsy is between 5%
and 7%.
axillary lymphadenectomy is approximately 20%
combination of axillary lymphadenectomy and radiation therapy reaches 25% to 40%
risk factors for secondary lymphedema ?
obesity, infections, radiation, and genetic predisposition.
Vascular anamoly cannot occures with lymphoedema?
vascular anomalies and limb growth disturbances that manifest in several primary lym phedema phenotypes and can influence natural history.
patients can present with a mixed picture of primary and secondary lymphedema.
T
What the Objective measurements for lymphoedema?
objective measurements used in clinical practice including
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement,
and circumferential measurement
the MD inderson calssificatin of lymphoedema depend on what ?
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
using LVA for lymphoedema can eliminate the need for continuous compression dressing.
objective benefit for patients with early-stage lymphedema potentially eliminating the
need for continued use of compression garments.
What is Stewart-Treves syndrome.?
Lymphangiosarcoma in a lymphedematous upper extremity after mastectomy is termed Stewart-Treves syndrome.
how much the ratio of lymphodema between apper and lower extermity?
9:1
Prevention is the most effective intervention for lymphedema.
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Lymphedema praecox
affects women four times as often as men
T
Prevention is the most effective intervention for lymphedema.
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
lymphedema tarda, also more common in women, presents after age 35. It accounts for
11% of primary cases
T
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Lymphedema praecox
affects women four times as often as men
T
Percentage of Lymphedema praecox
(77%-94%) of cases
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
the most commonly used
classification of primary lymphedema is based on the time of onset
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
Lymphedema praecox
affects women four times as often as men
T
Prevention is the most effective intervention for lymphedema.
T
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
Prevention is the most effective intervention for lymphedema.
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Lymphedema praecox
affects women four times as often as men
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
Prevention is the most effective intervention for lymphedema.
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Lymphedema praecox
affects women four times as often as men
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Percentage of Lymphedema praecox
(77%-94%) of cases
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
Prevention is the most effective intervention for lymphedema.
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
the most commonly used
classification of primary lymphedema is based on the time of onset
T
Percentage of Lymphedema praecox
(77%-94%) of cases
Lymphedema praecox
affects women four times as often as men
T
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
for gynecological and genitourinary
tumors. up to 75% of
these patients who developed secondary lymphedema
T
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
objective measurements
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement, and circumferential measurement
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
A 5 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
F A 2 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Prevention is the most effective intervention for lymphedema.
T
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Lymphedema praecox
affects women four times as often as men
T
Percentage of Lymphedema praecox
(77%-94%) of cases
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
Natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
for gynecological and genitourinary tumors. up to 75% of these patients who developed secondary lymphedema
T within the first year of surgery
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
A 5 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
F A 2 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
objective measurements
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement, and circumferential measurement
Prevention is the most effective intervention for lymphedema.
T
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
the most commonly used
classification of primary lymphedema is based on the time of onset
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Percentage of Lymphedema praecox
(77%-94%) of cases
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
Lymphedema praecox
affects women four times as often as men
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
Natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
objective measurements
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement, and circumferential measurement
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
for gynecological and genitourinary tumors. up to 75% of these patients who developed secondary lymphedema
T within the first year of surgery
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
A 5 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
F A 2 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
Lymphoscintigraphy, the most commonly used radiographic test in lymphedema assessment, is a qualitative test based
on detection of peripherally injected radiolabeled Technetium-99m colloid uptake by proximal nodal basins
T
quantification of disease severity can be don by
Near-infrared fluorescence lymphography with
indocyanine-green (ICG) has gained wider use, also as a qualitative test of lymphatic function
T
Near-infrared fluorescence lymphography BENEFITS
A qualitative test of lymphatic function.
correlated with the severity of disease
see flow in real time with this test is useful for intraoperative
navigation in microsurgical lymphatic reconstruction
the objective of surveillance is to detect subclinical interstitial fluid accumulation manifested by as little as 3% to 5% limb volume changes
T
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
T
Cheng’s lymphedema grading system in contrast bases its five-grade scheme on differential circumference at distinct anatomic landmarks (e.g., 10 cm above and
below the elbow joint in upper limbs) between the affected limb and uninvolved contralateral limb
T
Complete decongestive therapy (CDT) is considered the first line in lymphedema management
T
It is a multimodal approach that incorporates manual lymphatic drainage (MLD), compression bandaging,
exercise, and skin care
T
In phase I, patients
see a lymphedema specialist five times a week for up to 8 weeks and
undergo MLD, compression therapy, and physiotherapy to achieve limb volume reduction
T
liposuction combined with controlled compression therapy has been shown to be a safe and effective technique for significantly reducing limb volume.
T
Studies have also shown sustained limb volume reduction
with this technique up to 15 years after surgery
T
Liposuction can be don without tourniquet control
F Liposuction should be performed with tumescent technique and under tourniquet control to minimize blood loss and the need for transfusions.
. Contraindications
to liposuction
include metastatic disease, open wounds, medical history of coagulopathy, patients unfit for surgery, or patients
deemed unreliable to adhere to postoperative compressive therapy
Complications of liposuction
generally minor and include small
wound-healing problems, paresthesia, and contour irregularities.
Rapid recurrence occurs if the patient is noncompliant with postoperative compressive therapy
Direct excision techniques are not widely used
t
The procedure is fraught with risks including blood loss requiring transfusion, substantial skin graft failure
necessitating reoperations or prolonged wound care, acute infections, recurrence of lymphedema, contour irregularities, and unaesthetic appearance of the limb in the long term
t
LVA is considered by most authors to be appropriate for patients with early-stage lymphedema
T
These patients generally exhibit partial
lymphatic obstruction with residual patent lymphatic vessels on lymphoscintigraphy and ICG lymphography; moreover, they have not
developed extensive fibrosis and adipose hypertrophy
T
A tourniquet is not necessary for a bloodless field if the surgical
site is infiltrated locally with dilute epinephrine for vasoconstriction
T
here is no evidence associating a threshold number of anastomoses withlikelihood of success
T
current evidence demonstrates objective and subjective benefit for
patients with early-stage lymphedema potentially eliminating the need for continued use of compression garments
T
the number of vascularized lymph nodes in
the transferred flap is positively correlated with the degree of limb volume reduction
T
Groin lymph node flaps may be based on the superficial circumflex iliac, superficial inferior epigastric, or the deep
inferior epigastric artery
T
WHO YOU CAN avoid iatrogenic lower limb
lymphedema
avoiding dissection below the inguinal crease improves the chances of including
lymph nodes that drain the abdominal wall while leaving behind those that drain the lower limb
Drawbacks of submental lymph node flap include the potential
for injury to the marginal mandibular branch of the facial nerve
T
The merits of the submental lymph node flap are
that it has a substantial number of lymph nodes that have been correlated with better outcomes with VLNT
T
The supraclavicular flap is
based on the transverse cervical artery and branches of the external jugular vein
T
In the lateral thoracic lymph node flap,
axillary level I lymph nodes (inferior to lateral border of pectoralis minor) are harvested based on the lateral thoracic or thoracodorsal vessels
T
the omentum is a rich source of
lymphatic tissue and can be harvested in open or laparoscopic fashion.
T
Prevention is the most effective intervention for lymphedema.
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
the most commonly used
classification of primary lymphedema is based on the time of onset
T
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Lymphedema praecox
affects women four times as often as men
T
Percentage of Lymphedema praecox
(77%-94%) of cases
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
Natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
objective measurements
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement, and circumferential measurement
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
A 5 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
F A 2 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
Near-infrared fluorescence lymphography BENEFITS
A qualitative test of lymphatic function.
correlated with the severity of disease
see flow in real time with this test is useful for intraoperative
navigation in microsurgical lymphatic reconstruction
Quantification of disease severity can be done by Lymphoscintigraphy
F there is no standard protocol for quantifying radiocolloid uptake and transit time, making
it difficult to standardize quantification of disease severity
Near-infrared fluorescence lymphography with
indocyanine-green (ICG) has gained wider use, also as a qualitative test of lymphatic function
T
the objective of surveillance is to detect subclinical interstitial fluid accumulation manifested by as little as 3% to 5% limb volume changes
T
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
T
liposuction combined with controlled compression therapy has been shown to be a safe and effective technique for significantly reducing limb volume.
T
Liposuction can be don without tourniquet control
F Liposuction should be performed with tumescent technique and under tourniquet control to minimize blood loss and the need for transfusions.
. Contraindications
to liposuction
include metastatic disease, open wounds, medical history of coagulopathy, patients unfit for surgery, or patients
deemed unreliable to adhere to postoperative compressive therapy
Complications of liposuction
generally minor and include small
wound-healing problems, paresthesia, and contour irregularities.
Rapid recurrence occurs if the patient is noncompliant with postoperative compressive therapy
Direct excision techniques are not widely used
t
The procedure is fraught with risks including blood loss requiring transfusion, substantial skin graft failure
necessitating reoperations or prolonged wound care, acute infections, recurrence of lymphedema, contour irregularities, and unaesthetic appearance of the limb in the long term
t
LVA is considered by most authors to be appropriate for patients with early-stage lymphedema
T
These patients generally exhibit partial
lymphatic obstruction with residual patent lymphatic vessels on lymphoscintigraphy and ICG lymphography; moreover, they have not
developed extensive fibrosis and adipose hypertrophy
T
current evidence demonstrates objective and subjective benefit for
patients with early-stage lymphedema potentially eliminating the need for continued use of compression garments
T
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
Drawbacks of submental lymph node flap include the potential
for injury to the marginal mandibular branch of the facial nerve
T
The supraclavicular flap is
based on the transverse cervical artery and branches of the external jugular vein
T
the omentum is a rich source of
lymphatic tissue and can be harvested in open or laparoscopic fashion.
T
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
for gynecological and genitourinary tumors. up to 75% of these patients who developed secondary lymphedema
T within the first year of surgery
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
There is no evidence associating a threshold number of anastomoses withlikelihood of success
T
the number of vascularized lymph nodes in
the transferred flap is positively correlated with the degree of limb volume reduction
T
Groin lymph node flaps may be based on the superficial circumflex iliac, superficial inferior epigastric, or the deep
inferior epigastric artery
T
Complete decongestive therapy (CDT) is considered the first line in lymphedema management
T
Cheng’s lymphedema grading system in contrast bases its five-grade scheme on differential circumference at distinct anatomic landmarks (e.g., 10 cm above and
below the elbow joint in upper limbs) between the affected limb and uninvolved contralateral limb
T
Lymphoscintigraphy, the most commonly used radiographic test in lymphedema assessment, is a qualitative test based
on detection of peripherally injected radiolabeled Technetium-99m colloid uptake by proximal nodal basins
T
In the lateral thoracic lymph node flap,
axillary level I lymph nodes (inferior to lateral border of pectoralis minor) are harvested based on the lateral thoracic or thoracodorsal vessels
T
The merits of the submental lymph node flap are
that it has a substantial number of lymph nodes that have been correlated with better outcomes with VLNT
T
It is a multimodal approach that incorporates manual lymphatic drainage (MLD), compression bandaging,
exercise, and skin care
T
In phase I, patients
see a lymphedema specialist five times a week for up to 8 weeks and
undergo MLD, compression therapy, and physiotherapy to achieve limb volume reduction
T
Studies have also shown sustained limb volume reduction
with this technique up to 15 years after surgery
T
A tourniquet is not necessary for a bloodless field if the surgical
site is infiltrated locally with dilute epinephrine for vasoconstriction
T
WHO YOU CAN avoid iatrogenic lower limb
lymphedema
avoiding dissection below the inguinal crease improves the chances of including
lymph nodes that drain the abdominal wall while leaving behind those that drain the lower limb
Prevention is the most effective intervention for lymphedema.
T
Lymphovenous anastomosis is indicated in any stages
of lymphedema
F Lymphovenous anastomosis is indicated in the early stages
of lymphedema
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
the most commonly used
classification of primary lymphedema is based on the time of onset
T
The types of primary lymphedema
congenital lymphedema, lymphedema praecox,
and lymphedema tarda
Congenital lymphedema presents at birth,
and it accounts for 20% to 30% of primary cases
F Congenital lymphedema presents at birth,
and it accounts for 6% to 12% of primary cases
Women are affected twice as often as men, and the lower limb is involved three times as commonly as the upper limb.
T
Lymphedema praecox
affects women four times as often as men
T
Percentage of Lymphedema praecox
(77%-94%) of cases
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
advances in molecular techniques have contributed to
identifying causal mutations linked to specific phenotypes ofprimary lymphedema
T
lymphedema tarda, also more common in women, presents after age 35. It accounts for 11% of primary cases
T
Lymphedema praecox presents most
commonly as unilateral lower limb edema after birth up to age 35.
T
In middle and high-income countries, the most common cause of secondary lymphedema is tissue trauma from surgical procedures
T
The incidence of
lymphedema following sentinel lymph node biopsy is between 5% and 7%.
T
risk-reducing behaviors
include avoidance of venipuncture, blood pressure monitoring, and
resistance exercise involving at-risk limbs
T
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
for patients who undergo
a combination of axillary lymphadenectomy and radiation therapy
reaches 25% to 40%.
Natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
obesity and infections are potentially
controllable risk factors that should be acted upon by clinicians who
encounter high-risk patients
T
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
for gynecological and genitourinary tumors. up to 75% of these patients who developed secondary lymphedema
T within the first year of surgery
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
objective measurements
bioimpedance spectroscopy,
perometry,
skin tonometry,
tissue dielectric constant,
water displacement, and circumferential measurement
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
Near-infrared fluorescence lymphography with
indocyanine-green (ICG) has gained wider use, also as a qualitative test of lymphatic function
T
the objective of surveillance is to detect subclinical interstitial fluid accumulation manifested by as little as 3% to 5% limb volume changes
T
Near-infrared fluorescence lymphography BENEFITS
A qualitative test of lymphatic function.
correlated with the severity of disease
see flow in real time with this test is useful for intraoperative
navigation in microsurgical lymphatic reconstruction
Complete decongestive therapy (CDT) is considered the first line in lymphedema management
T
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
T
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
Lymphoscintigraphy, the most commonly used radiographic test in lymphedema assessment, is a qualitative test based
on detection of peripherally injected radiolabeled Technetium-99m colloid uptake by proximal nodal basins
T
In phase I, patients
see a lymphedema specialist five times a week for up to 8 weeks and
undergo MLD, compression therapy, and physiotherapy to achieve limb volume reduction
T
liposuction combined with controlled compression therapy has been shown to be a safe and effective technique for significantly reducing limb volume.
T
Studies have also shown sustained limb volume reduction
with this technique up to 15 years after surgery
T
. Contraindications
to liposuction
include metastatic disease, open wounds, medical history of coagulopathy, patients unfit for surgery, or patients
deemed unreliable to adhere to postoperative compressive therapy
The procedure is fraught with risks including blood loss requiring transfusion, substantial skin graft failure
necessitating reoperations or prolonged wound care, acute infections, recurrence of lymphedema, contour irregularities, and unaesthetic appearance of the limb in the long term
t
It is a multimodal approach that incorporates manual lymphatic drainage (MLD), compression bandaging,
exercise, and skin care
T
LVA is considered by most authors to be appropriate for patients with early-stage lymphedema
T
A tourniquet is not necessary for a bloodless field if the surgical
site is infiltrated locally with dilute epinephrine for vasoconstriction
T
There is no evidence associating a threshold number of anastomoses withlikelihood of success
T
Liposuction can be don without tourniquet control
F Liposuction should be performed with tumescent technique and under tourniquet control to minimize blood loss and the need for transfusions.
Complications of liposuction
generally minor and include small
wound-healing problems, paresthesia, and contour irregularities.
Rapid recurrence occurs if the patient is noncompliant with postoperative compressive therapy
These patients generally exhibit partial
lymphatic obstruction with residual patent lymphatic vessels on lymphoscintigraphy and ICG lymphography; moreover, they have not
developed extensive fibrosis and adipose hypertrophy
T
the number of vascularized lymph nodes in
the transferred flap is positively correlated with the degree of limb volume reduction
T
WHO YOU CAN avoid iatrogenic lower limb
lymphedema
avoiding dissection below the inguinal crease improves the chances of including
lymph nodes that drain the abdominal wall while leaving behind those that drain the lower limb
current evidence demonstrates objective and subjective benefit for
patients with early-stage lymphedema potentially eliminating the need for continued use of compression garments
T
The merits of the submental lymph node flap are
that it has a substantial number of lymph nodes that have been correlated with better outcomes with VLNT
T
Groin lymph node flaps may be based on the superficial circumflex iliac, superficial inferior epigastric, or the deep
inferior epigastric artery
T
The supraclavicular flap is
based on the transverse cervical artery and branches of the external jugular vein
T
In the lateral thoracic lymph node flap,
axillary level I lymph nodes (inferior to lateral border of pectoralis minor) are harvested based on the lateral thoracic or thoracodorsal vessels
T
The omentum is a rich source of
lymphatic tissue and can be harvested in open or laparoscopic fashion.
T
Cheng’s lymphedema grading system in contrast bases its five-grade scheme on differential circumference at distinct anatomic landmarks (e.g., 10 cm above and
below the elbow joint in upper limbs) between the affected limb and uninvolved contralateral limb
T
Direct excision techniques are not widely used
t
Drawbacks of submental lymph node flap include the potential
for injury to the marginal mandibular branch of the facial nerve
T
Prevention is the most effective intervention for lymphedema.
T
Genetic derangements underlie the disease mechanisms in primary lymphedema,
T
primary lymphederna is most commonly classified by
time of onset, this classification is insufficient to account for phenotypic variations within categories
T
Lymphedema praecox
affects women four times as often as men
T
Natural history perhaps depends
more on underlying causal mutations and their penetrance rather than time of onset.
T
classification by underlying mechanism necessitates consideration of other associated features such as
vascular anomalies and limb growth disturbances that manifest in several primary lymphedema phenotypes and can influence natural history.
T
Patients who develop BCRL typically present an average of 8 to 12 months after surgery
T
77% of patients who will develop
BCRL do so by the third year after surgery and then the risk is approximately 1 % per year
T
Risk factors for secondary lymphedema include
Obesity, infections, radiation, and genetic predisposition
Clinicians must also consider that patients can present with a mixed picture of primary and secondary lymphedema.
t
The incidence for patients who undergo axillary lymphadenectomy
is approximately 20%
Water displacement (volume of water a limb displaces when
immersed) is considered the most accurate measurement because of its high reliability
T
for gynecological and genitourinary tumors. up to 75% of these patients who developed secondary lymphedema
T within the first year of surgery
Circumferential measurements are the most commonly used measure in clinical practice and if properly performed meet the desired criteria outlined earlier
T
Lymphoscintigraphy, the most commonly used radiographic test in lymphedema assessment, is a qualitative test based
on detection of peripherally injected radiolabeled Technetium-99m colloid uptake by proximal nodal basins
T
A 5 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
F A 2 cm or greater increase in circumference is widely
accepted as the definition of lymphedema
Near-infrared fluorescence lymphography BENEFITS
A qualitative test of lymphatic function.
correlated with the severity of disease
see flow in real time with this test is useful for intraoperative
navigation in microsurgical lymphatic reconstruction
Quantification of disease severity can be done by Lymphoscintigraphy
F there is no standard protocol for quantifying radiocolloid uptake and transit time, making
it difficult to standardize quantification of disease severity
Cheng’s lymphedema grading system in contrast bases its five-grade scheme on differential circumference at distinct anatomic landmarks (e.g., 10 cm above and
below the elbow joint in upper limbs) between the affected limb and uninvolved contralateral limb
T
The first sign of lymphoedema
begins with pitting edema that correlates with the interstitial accumulation of protein-rich ultrafiltrate
The MD Anderson classification defines stages of lymphedema based
on flow patterns observed on ICG lymphography
T
Complete decongestive therapy (CDT) is considered the first line in lymphedema management
T
In phase I, patients
see a lymphedema specialist five times a week for up to 8 weeks and
undergo MLD, compression therapy, and physiotherapy to achieve limb volume reduction
T
Studies have also shown sustained limb volume reduction
with this technique up to 15 years after surgery
T
It is a multimodal approach that incorporates manual lymphatic drainage (MLD), compression bandaging,
exercise, and skin care
T
Near-infrared fluorescence lymphography with
indocyanine-green (ICG) has gained wider use, also as a qualitative test of lymphatic function
T
Complications of liposuction
generally minor and include small
wound-healing problems, paresthesia, and contour irregularities.
Rapid recurrence occurs if the patient is noncompliant with postoperative compressive therapy
. Contraindications
to liposuction
include metastatic disease, open wounds, medical history of coagulopathy, patients unfit for surgery, or patients
deemed unreliable to adhere to postoperative compressive therapy
Liposuction can be don without tourniquet control
F Liposuction should be performed with tumescent technique and under tourniquet control to minimize blood loss and the need for transfusions.
The procedure is fraught with risks including blood loss requiring transfusion, substantial skin graft failure
necessitating reoperations or prolonged wound care, acute infections, recurrence of lymphedema, contour irregularities, and unaesthetic appearance of the limb in the long term
t
current evidence demonstrates objective and subjective benefit for
patients with early-stage lymphedema potentially eliminating the need for continued use of compression garments
T
the objective of surveillance is to detect subclinical interstitial fluid accumulation manifested by as little as 3% to 5% limb volume changes
T
Drawbacks of submental lymph node flap include the potential
for injury to the marginal mandibular branch of the facial nerve
T
These patients generally exhibit partial
lymphatic obstruction with residual patent lymphatic vessels on lymphoscintigraphy and ICG lymphography; moreover, they have not
developed extensive fibrosis and adipose hypertrophy
T
LVA is considered by most authors to be appropriate for patients with early-stage lymphedema
T
The merits of the submental lymph node flap are
that it has a substantial number of lymph nodes that have been correlated with better outcomes with VLNT
T
The supraclavicular flap is
based on the transverse cervical artery and branches of the external jugular vein
T
There is no evidence associating a threshold number of anastomoses withlikelihood of success
T
the number of vascularized lymph nodes in
the transferred flap is positively correlated with the degree of limb volume reduction
T
In the lateral thoracic lymph node flap,
axillary level I lymph nodes (inferior to lateral border of pectoralis minor) are harvested based on the lateral thoracic or thoracodorsal vessels
T
The omentum is a rich source of
lymphatic tissue and can be harvested in open or laparoscopic fashion.
T
liposuction combined with controlled compression therapy has been shown to be a safe and effective technique for significantly reducing limb volume.
T
Direct excision techniques are not widely used
t
A tourniquet is not necessary for a bloodless field if the surgical
site is infiltrated locally with dilute epinephrine for vasoconstriction
T
Groin lymph node flaps may be based on the superficial circumflex iliac, superficial inferior epigastric, or the deep
inferior epigastric artery
T
WHO YOU CAN avoid iatrogenic lower limb
lymphedema
avoiding dissection below the inguinal crease improves the chances of including
lymph nodes that drain the abdominal wall while leaving behind those that drain the lower limb
