PMC6256967_01
Case No. 1. (a) Clinical examination in the 21-year-old woman before surgery demonstrating a huge hand lymphedema. (b) Normal right hand 6 months after surgery. (c) Scar at the donor site below the iliac crest 1 year after surgery. (d) No lymphedema exists in the lower limbs 1 year after the lymph node flap harvesting.
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F1
The hand was so swollen (Figure 1a) and painful that the young woman stopped her studies. At the 1-year follow-up, the hand was nearly normal (Figure 1b) and there is no lower limb lymphedema (Figures 1c and 1d).
Peroperative procedure. (a) Product of extrafascial dermolipectomy at hand level. (b) The flap containing the nodes around the superficial vein is elevated deeply onto the fascia, to the superficial iliac artery and the veins that emerge from the femoral vein and artery, at the internal part, near the pubis crest. (c) The flap placed in the elbow region. Microsurgical anastomosis is performed on the microscope, with separated points (6-8) on the receiving vessels (Nylon 10 x 0).
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F2
An extrafascial dermolipectomy was first performed (Figure 2a). The autologous donor flap harvested at groin level (Figure 2b) was transferred to elbow level. One arterial and one venous anastomosis were performed to connect flap vessels to perforate branches (artery and vein) around the elbow (Figure 2c).
PMC6256967_02
Clinical examination in the 26-year-old woman (Case No. 2) before surgery, demonstrating a huge hand lymphedema.
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F3
Unable to work because of hand impairment, she lost her job and could not find a new job because of the monstrous aspect of her hand (Figure 3).
(a) Noncontrast magnetic resonance lymphography before surgery in the 26-year-old woman (Case No. 2) demonstrating lymphedema of right hand with subcutaneous tissue infiltration (I) and dilatation (arrows) of distal lymphatic vessels of the forearm. (b) Normal noncontrast magnetic resonance lymphography of the wrist and forearm.
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F4
An obstruction of the LF at elbow level was confirmed by NCMRL (Figure 4a) compared to normal aspect (Figure 4b).
Case No. 2 after surgery. (a) Clinical examination in the 26-year-old woman (Case 2) 6 months after surgery, showing a normal right hand. (b) Noncontrast magnetic resonance lymphography 1 year after surgery showing new lymphatic vessels at elbow level. (c) Noncontrast magnetic resonance lymphography 1 year after surgery showing normal lymphatic circulation at wrist and hand level.
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F5
The hand quickly ameliorated (Figure 5a) and was functional after 6 months, allowing the patient to work again. The postoperative NCMRL showed new LVs at elbow level (Figure 5b) and normal LF (Figure 5c).