Following publication of this blog post the trial has been paused whilst options for funding are considered.
Lymphoedema is a debilitating condition occurring in 4% of patients seeking breast reconstruction. There have been recent reports of free vascularised transplantation of lymph nodes. The exact mechanism of action is still unclear, but it is thought that transfer of lymph nodes results in endogenous growth factor expression which induces regrowth of lymphatic networks.
Lymphoscintigraphy confirms that initially closed lymphatics open and the distal vessels sprout to re-establish a lymphatic network. This technique is technically much easier than micro-lymphatic procedures and has been shown to consistently improve post-mastectomy upper limb oedema.
For those patients wanting breast reconstruction, a superficial inguinal lymph node flap can be raised in continuity with a DIEP flap. Addition of the lymph nodes to the DIEP flap adds approximately fifteen minutes to the operative time. To date we have performed this procedure in 30 patients with symptomatic improvements in all cases and no evidence of lymphatic impairment in the lower limb.
There is evidence that simple release of scar tissue during the breast reconstruction can improve lymphoedema, and an RCT would therefore be necessary to evaluate this technique. We therefore propose a multicentre RCT and invite other units to participate in this exciting new development.
Anne Dancey, Birmingham