Abstracts LymphForsch 1/2012

Diagnosis and therapy of lymphatic malformations in the head and neck region

A. Braunschweiger, J.-E. Otten, J. Rößler, LymphForsch 2012,16(1)6-11

Lymphatic malformations (LMs) are often localized in the head and neck region. At the University Medical Center Freiburg, an interdisciplinary team of oral and maxillofacial sur­ geons, plastic surgeons, pediatric surgeons, vascular surgeons, orthopedists, radiologists, neuroradiologists, ophthalmologists, ENT surgeons, dermatologists and lymphologists treat LMs. In this retrospective analysis, we evaluate the diagnostic procedures and therapeutic approaches used for the patients at this interdisciplinary center.

From January 2006 to December 2009, medical files of 22 patients with 24 LMs were eva­ luated. In addition to a base ultrasound performed in all patients, 20 patients underwent an MRI exam during diagnostic work­up. Surgery was performed to treat ten LMs, while sclerotherapy was used to treat five LMs followed by lymphatic drainage for two LMs. Ten LMs were not treated.

MRI is the diagnostic gold standard for optimal planning therapy for LMs of the head and neck region. All therapeutic approaches resulted in improved clinical situations for the pati­ ents regarding LM size and functional deficits. This interdisciplinary approach to LM treat­ ment appears to lead to positive therapeutic results.

Keywords: Lymphatic malformations, lymphangioma, lymphedema, diagnostics, therapy, MRI, ultrasound, sclerotherapy, surgery, MLD

Microsurgical teatment of peripheral lymphoceles

T. Aung, J. Wilting, G. Felmerer, LymphForsch 2012;16(1)14-19

Lymphoceles are pseudo­cysts filled with lymphatic fluid occurring after injuries or surgical interventions. In this study, we investigated whether microsurgical resection with visualiza­ tion of afferent lymphatics or anastomosing of lymphatic collectors prevents relapse of this obstructive situation. Our immunohistological investigations showed that lymphoceles are not lined with endothelium. In the capsule of the lymphocele, very few lymphatic vessels can be stained with the endothelial markers CD31, Prox1, Lyve­1 and podoplanin. In the past two years, we performed surgery on twelve lymphoceles. A lymph collector transplan­ tation was concurrently performed on two patients with chronic extremity lymphedema. Among the twelve operations, there was only one recurrence, which was obviously caused by too early onset of manual lymphatic drainage. However, this was remedied by repetitive puncturing. The microsurgical resection of lymphoceles should be offered to all patients undergoing nonsuccessful conservative treatment. It is an important part of the integrated therapeutic concept in lymphology.

Keywords: lymphoceles, extremity lymphedema, lymph collector transplantation, lympho­ venous anastomosis

Decongestive Lymphedema treatment on an outpatient basis in a specialized out-patient practice - Results of a pilot study

H. Pritschow, C. Schuchhardt, LymphForsch 2012; 16(1)20-23

An evaluation of CDT treatment results of 158 patients with lymphedema and combination forms undertaken between 2009 and 2011 showed that decongestion of lymphedema can be achieved in a physical therapy out-patient practice. Our treatment center is primarily spe- cialized in out-patient complete physical decongestive therapy and is part of the interdiscip- linary lymphedema patient-centered care. This overall study showed that decongestion could be achieved with an average of 9.57 CPT treatments. From a sociomedical point of view, it is worth mentioning that 29 % of the patients were still working during CPT treatment, 14 % had taken sick leave, 46 % were retired persons and 10 % had applied for vacation.

Keywords: outpatient lymphedema therapy, complete physical decongestive therapy (CDT), secondary arm lymphedema, secondary leg lymphedema, phlebolymphostatic edema