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Lymphatic microsurgery today for the treatment of peripheral lymphedema: indications, techniques and long-term clinical outcome
Vol. 215, No. 3S, September 2012
METHODS: Seven dog transplants were performed across a minor mismatched barrier. Four received two Gy radiation, donor marrow, short course of post-graft immunosuppresion, and a VCA transplant. Three did not receive marrow. For T-regs identification, FoxP3 expression was assessed by immunohistochemistry and PCR. Helios was used to differentiate natural from peripheral T-regs. RESULTS: Dogs that received donor marrow became tolerant to their VCAs. Dogs not receiving marrow rejected their VCAs. Early post-transplant, higher numbers of T-regs were found in the peripheral blood of tolerant versus non-tolerant dogs. This difference disappeared after five weeks. However, long-lasting expression of FoxP3 and Helios (⬎one year) was observed in thymus and VCA tissues taken from tolerant dogs when compared to non-tolerant dogs.
Abstracts
S91
treatment of both primary and secondary peripheral lymphedema, above all in early stages when tissue changes are slight, allowing an optimal restore of lymphatic drainage. Death and ICU level complications in laryngeal and pharyngeal surgery: The National Surgical Quality Improvement Program (NSQIP) multi-specialty story of patients who are high risk for death Alfredo C Cordova, MD, Tamer Ghanem, MD, PhD, FACS, Francis Hall, MD, Robert Stachler, MD, Jennifer Ritz, RN, Anthony Falvo, DO, Ilan S Rubinfeld, MD, FACS Henry Ford Hospital, Detriot, MI
CONCLUSIONS: Given the differences between tolerant and nontolerant dogs, these observations suggest that T-regs function to mediate tolerance. Thymic derived, or natural T-regs might travel from the thymus into the peripheral blood early post-transplantation. Afterwards they reside in the skin and muscle of the VCA and establish a local tolerance effect that is long lasting.
INTRODUCTION: Head and Neck surgeons operate on an increasingly aging population, performing technically demanding procedures with an expectation of very low mortality and only minor morbidity. As focus on quality and outcomes increases it become necessary to improve preoperative risk stratification in order to indentify those at highest risk. Frailty has been suggested as one such method to risk stratify outcomes and improve planning. We hypothesized that frailty would allow us to risk stratify the Larygectomy and Pharyngectomy patient.
Lymphatic microsurgery today for the treatment of peripheral lymphedema: indications, techniques and longterm clinical outcome Corradino Campisi, MD, PhD, FACS, Lorenz Larcher, MD, Rosalia Lavagno, MD, Francesco Boccardo, MD, PhD University of Genoa, Genoa, Italy
METHODS: We obtained 6 years of the National Surgical Quality Improvement Project Partidicupant Use Files (2005-2010). We stratified outcomes using the Clavien Classification, with 4 including all adverse events resulting in organ failure and ICU stay, and 5 being death. Frailty was determined using a modified frailty score based on the Canadian Study of Health and Aging. Fisher’s exact and Chisquare analyses were performed in SPSS 20 (IBM, NY).
INTRODUCTION: Authors’ wide surgical play in the therapy of both primary and secondary peripheral lymphedema by microsurgical procedures is mentioned as performed at the Centre of Lymphatic Surgery and Microsurgery of the University of Genoa, Italy. The objective is to report the over 30 years vast clinical experience and the consistent long-lasting outcome concerning the treatment of peripheral lymphedema by advanced derivative and reconstructive microsurgical techniques.
RESULTS: A total of 332 patients underwent either a laryngectomy or pharyngectomy during the period of study. Patient with Clavien 4 complication had mortality of 18%, odds ratio of 25, p ⬍.001. Patients with post operative hemorrhage had a 10% mortality, OR 12, p ⫽ .007. Reintubation was associated with 18.2% mortality, OR 11.6, p⬍.025. Frailty stratified results are in table 1.
METHODS: Between 1973 and 2011, over 2500 patients affected by both primary and secondary peripheral lymphedema underwent lymphatic microsurgery including derivative multiple lymphaticvenous anastomoses (LVA technique) and lymphatic reconstruction by interpositioned vein grafted shunts (LVLA technique). Results were objectively assessed by volumetry and lymphoscintigraphy. The outcome was analyzed in terms of long-term excess volume reduction (EVR), post-operative decrease of dermatolymphangioadenitis (DLA) attacks and necessity of conservative therapy.
Adverse event
RESULTS: Volume changes showed a significant improvement, till over 84% EVR comparing pre-operative conditions, with an average follow-up of more than 10 years. Among patients with lymphedema at earlier stages (stage I and stage II A), over 86% could progressively give up the use of conservative measures and 42% of patients with late stage lymphedema (stage II B and stage III) could decrease the use of physical therapies. Most considerably, the considerable EVR diminished DLA attacks of about 91%. CONCLUSIONS: Microsurgical lymphatic derivative and reconstructive techniques allow to bring about excellent results in the
Occurrence with FI 0.0
Occurrence with FI .09
Occurrence with FI 0.18
Occurrence with FI 0.27
p Value
Clavien 4
1.7%
8.2%
6.6%
16.7%
.008
Clavien 4 and 5
2.6%
9.2%
6.6%
21.4%
.001
CONCLUSIONS: Frailty may be an effective method to risk stratify larygectomy and pharygectomy patients. Improved risk stratification could lead to better preoperative planning and outcomes. Lessons learned in establishing the first preclinical, orthotopic, large animal maxillofacial transplant model Erin M Rada, MD, Kate Buretta, BS, Gabriel Santiago, MD, Jaimie Shores, MD, Steven Bonawitz, MD, Justin M Sacks, MD, Gerald Grant, DMD, Gerald Brandacher, MD, WP Andrew Lee, MD, FACS, Chad R Gordon, DO Johns Hopkins University, Baltimore, MD, Walter Reed National Military Medical Center, Bethesda, MD WITHDRAWN
METHODS: Seven dog transplants were performed across a minor mismatched barrier. Four received two Gy radiation, donor marrow, short course of post-graft immunosuppresion, and a VCA transplant. Three did not receive marrow. For T-regs identification, FoxP3 expression was assessed by immunohistochemistry and PCR. Helios was used to differentiate natural from peripheral T-regs. RESULTS: Dogs that received donor marrow became tolerant to their VCAs. Dogs not receiving marrow rejected their VCAs. Early post-transplant, higher numbers of T-regs were found in the peripheral blood of tolerant versus non-tolerant dogs. This difference disappeared after five weeks. However, long-lasting expression of FoxP3 and Helios (⬎one year) was observed in thymus and VCA tissues taken from tolerant dogs when compared to non-tolerant dogs.
Abstracts
S91
treatment of both primary and secondary peripheral lymphedema, above all in early stages when tissue changes are slight, allowing an optimal restore of lymphatic drainage. Death and ICU level complications in laryngeal and pharyngeal surgery: The National Surgical Quality Improvement Program (NSQIP) multi-specialty story of patients who are high risk for death Alfredo C Cordova, MD, Tamer Ghanem, MD, PhD, FACS, Francis Hall, MD, Robert Stachler, MD, Jennifer Ritz, RN, Anthony Falvo, DO, Ilan S Rubinfeld, MD, FACS Henry Ford Hospital, Detriot, MI
CONCLUSIONS: Given the differences between tolerant and nontolerant dogs, these observations suggest that T-regs function to mediate tolerance. Thymic derived, or natural T-regs might travel from the thymus into the peripheral blood early post-transplantation. Afterwards they reside in the skin and muscle of the VCA and establish a local tolerance effect that is long lasting.
INTRODUCTION: Head and Neck surgeons operate on an increasingly aging population, performing technically demanding procedures with an expectation of very low mortality and only minor morbidity. As focus on quality and outcomes increases it become necessary to improve preoperative risk stratification in order to indentify those at highest risk. Frailty has been suggested as one such method to risk stratify outcomes and improve planning. We hypothesized that frailty would allow us to risk stratify the Larygectomy and Pharyngectomy patient.
Lymphatic microsurgery today for the treatment of peripheral lymphedema: indications, techniques and longterm clinical outcome Corradino Campisi, MD, PhD, FACS, Lorenz Larcher, MD, Rosalia Lavagno, MD, Francesco Boccardo, MD, PhD University of Genoa, Genoa, Italy
METHODS: We obtained 6 years of the National Surgical Quality Improvement Project Partidicupant Use Files (2005-2010). We stratified outcomes using the Clavien Classification, with 4 including all adverse events resulting in organ failure and ICU stay, and 5 being death. Frailty was determined using a modified frailty score based on the Canadian Study of Health and Aging. Fisher’s exact and Chisquare analyses were performed in SPSS 20 (IBM, NY).
INTRODUCTION: Authors’ wide surgical play in the therapy of both primary and secondary peripheral lymphedema by microsurgical procedures is mentioned as performed at the Centre of Lymphatic Surgery and Microsurgery of the University of Genoa, Italy. The objective is to report the over 30 years vast clinical experience and the consistent long-lasting outcome concerning the treatment of peripheral lymphedema by advanced derivative and reconstructive microsurgical techniques.
RESULTS: A total of 332 patients underwent either a laryngectomy or pharyngectomy during the period of study. Patient with Clavien 4 complication had mortality of 18%, odds ratio of 25, p ⬍.001. Patients with post operative hemorrhage had a 10% mortality, OR 12, p ⫽ .007. Reintubation was associated with 18.2% mortality, OR 11.6, p⬍.025. Frailty stratified results are in table 1.
METHODS: Between 1973 and 2011, over 2500 patients affected by both primary and secondary peripheral lymphedema underwent lymphatic microsurgery including derivative multiple lymphaticvenous anastomoses (LVA technique) and lymphatic reconstruction by interpositioned vein grafted shunts (LVLA technique). Results were objectively assessed by volumetry and lymphoscintigraphy. The outcome was analyzed in terms of long-term excess volume reduction (EVR), post-operative decrease of dermatolymphangioadenitis (DLA) attacks and necessity of conservative therapy.
Adverse event
RESULTS: Volume changes showed a significant improvement, till over 84% EVR comparing pre-operative conditions, with an average follow-up of more than 10 years. Among patients with lymphedema at earlier stages (stage I and stage II A), over 86% could progressively give up the use of conservative measures and 42% of patients with late stage lymphedema (stage II B and stage III) could decrease the use of physical therapies. Most considerably, the considerable EVR diminished DLA attacks of about 91%. CONCLUSIONS: Microsurgical lymphatic derivative and reconstructive techniques allow to bring about excellent results in the
Occurrence with FI 0.0
Occurrence with FI .09
Occurrence with FI 0.18
Occurrence with FI 0.27
p Value
Clavien 4
1.7%
8.2%
6.6%
16.7%
.008
Clavien 4 and 5
2.6%
9.2%
6.6%
21.4%
.001
CONCLUSIONS: Frailty may be an effective method to risk stratify larygectomy and pharygectomy patients. Improved risk stratification could lead to better preoperative planning and outcomes. Lessons learned in establishing the first preclinical, orthotopic, large animal maxillofacial transplant model Erin M Rada, MD, Kate Buretta, BS, Gabriel Santiago, MD, Jaimie Shores, MD, Steven Bonawitz, MD, Justin M Sacks, MD, Gerald Grant, DMD, Gerald Brandacher, MD, WP Andrew Lee, MD, FACS, Chad R Gordon, DO Johns Hopkins University, Baltimore, MD, Walter Reed National Military Medical Center, Bethesda, MD WITHDRAWN