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American Association of Plastic Surgeons

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Effect Of Axillary Scar Excision On Local Venous Flow Velocities Of The Lymphedematous Limb
Grace Um, MD1, Laura Tom, MD2, Lindsay Cattin, BA1, Rana Farhadi, MD1, Minh-Bao Mundschenk, MD1, William Schmitt, MD3, Peter Neligan, MB, FRCS, FRCSC, FACS1.
1University of Washington, Seattle, WA, USA, 2Georgetown University, Washington D.C., DC, USA, 3Virginia Mason, Seattle, WA, USA.

PURPOSE:
Lymphedema is a debilitating and incurable disease for which new surgical treatment modalities continue to be researched and refined. At the time of vascularized lymph node transfer or lymphovenous anastomosis, clearance of axillary scar tissue that has formed from previous surgeries around the axillary vein can result in visible and immediate improvement in venous outflow. The effect on axillary scar clearance on better overall lymphatic drainage of the affected limb has not been adequately researched. METHODS:
Patients undergoing surgery for treatment of their lymphedema were enrolled in this prospective study. All procedures were done in the standard fashion, with the only difference being the non-invasive measurement of blood flow and resistance using a MediStim flowmeter before and after scar tissue was cleared around the axillary veins. RESULTS:
Of the 45 patients enrolled, flowmeter data was obtained in 39 cases. 37 (94.9%) female, 2 (5.1%) male. Data from 4 cases (10.3%) was excluded due to issues with device calibration and negative flow values. Increase in venous flow in mL/min was seen in 23 cases (65.7%) with a mean difference of 11.8 mL/min (p = 0.34). Index of flow resistance was also measured in 38 cases; decreased resistance was observed in 22 cases (57.9%), mean difference of 3.5 (p = 0.04).
CONCLUSION:
Axillary scar clearance at the time of surgical intervention in the treatment of lymphedema can increase venous outflow. Further study is needed on ultimate effect on lymphatic drainage and clinical improvement of symptoms.


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