E-Book, Englisch, 284 Seiten, ePub
ISBN: 978-3-13-258238-5
Verlag: Thieme
Format: EPUB
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)
Featuring current perspectives and particularities of surgical lymphedema treatment with contributions from international experts in the field, this innovative book describes evidence-based, multi-disciplinary approaches to treating chronic lymphedema from the point of view of clinical experts. It is also a comprehensive companion for multi-professional specialists looking for an erudite understanding of the complex treatment of lymphedema.
Ultimately, the book seeks to advance the contemporary understanding that underpins the philosophy and general principles of modern surgical management of chronic lymphedema, in order to improve the quality of life of patients.
Key highlights:
- Firsthand clinical pearls for treating lymphedema patients and managing the often-chronic issues that significantly impact on daily quality of life
- General focus on the fields of embryology, anatomy, physiology, and pathophysiology of the lymphatic system
- Special focus on diagnosis, evaluation, and complete decongestive therapy (CDT)
- Step-by-step descriptions of the surgical corner-stones, including lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and alternative supermicrosurgical techniques, as well as reductive and lymphoablative surgery
- Unique contributions on the diagnosis and treatment of lymphatic filariasis
- Basic concepts of experimental research in the field
- Evidence- and expert-based algorithm for personalized and stage-dependent treatment
- Over 70 full-color and highly instructive illustrations and more than 250 clinical images
This is a valuable and practical resource for surgeons of various clinical fields with supermicrosurgical expertise, lymphologists and angiologists, general practitioners, psychologists, lymphedema therapists, dietitians, specialized nurses, as well as medical students.
This book includes complimentary access to a digital copy on https://medone.thieme.com.
Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
Section I: Lymphology and Clinical Presentation
1 Lymphatic System
2 Epidemiological, Clinical, and Pathophysiological Aspects
3 Lymphatic Filariasis
Section II: Diagnostic Evaluation
4 Diagnostics and Stage-Dependent, Preoperative Evaluation
Section III: Modern Management of Chronic Lymphedema
5 Establishment of an Interprofessional and Multidisciplinary Lymphedema Network
Section IV: Non-Surgical Treatment and Techniques
6 Integrative, Multiprofessional Conservative Treatment
Section V: Surgical Treatment and Techniques
7 Basic Principles of Surgical Treatment and Accompanying Complete Decongestive Therapy
Section VI: Lymphoreconstructive Procedures
8 Lymphovenous Anastomosis
9 Autologous Lymph Vessel Transfer
10 Vascularized Lymph Nodes Transfer
11 Autologous Breast Reconstruction in Conjunction with Lymphatic Surgery
12 Nodo-Venal Shunt Microsurgery
Section VII: Lymphoreductive Procedures, Secondary Procedures, and Tips and Tricks
13 Suction-Assisted Lipectomy
14 Excisional Procedures
15 Secondary Procedures After Reconstructive Microsurgery
16 Tips and Tricks for Modern Surgical Management of Chronic Lymphedema
Section VIII: Training, Treatment Algorithm, Outcomes, and Further Developments
17 Teaching and Training in Lymphoreconstructive Surgery
18 Treatment Algorithm for the Surgical Management of Lymphedema
19 Review of the Current Literature
20 Experimental Research and Future Directions
1 Lymphatic System
Summary Throughout the history of vascular biology, the specific and very complex microvascular lymphatic vascular system had not been studied in detail until very recently. A comprehensive understanding only occurred due to tools that guaranteed accurate visualization and allowed for the use of specific cell and tissue markers. Continuous progress of these tools resulted in an increased understanding of the lymphatic vascular system from various perspectives. From an embryological point of view, the lymphatic vascular system depends on a complex interplay of cellular and molecular mechanisms controlling its de novo development. Powerful tools that visualize the lymphatic anatomy on a microscopic level have enabled a better understanding of this vascular system not only from a purely anatomical, but also from a physiological point of view, including preservation of tissue fluid balance, absorption of dietary fats, and immunosurveillance, and finally, lymphangiogenesis, which is a complex process of lymphatic cell differentiation, proliferation, migration, sprouting, and eventually tube formation, to create a new microvascular network that occurs not only in early embryological stages, but also in different clinically relevant conditions such as lymphedema, atherosclerosis, cancer, chronic inflammation, dermal infections, fibrosis, hypertension, or obesity. This introductory chapter highlights embryological, anatomical, and physiological issues of the lymphatic vascular system. 1.1 Embryology of the Lymphatic System
Florian Früh, Patrick A. Will, and Epameinondas Gousopoulos The lymphatic vascular system has been substantially neglected in the history of vascular biology. Due to the challenge of its visualization and the absence of specific markers, the lymphatic system has been ignored and its anatomy was specified only at the beginning of the 19th century. The identification of specific lymphatic markers in the late 1990s as well as subsequent molecular genetic studies revolutionized our understanding of the mechanisms involved in specification, expansion, and maturation of the lymphatic system. ? [1] From a morphological point of view, the murine lymphatic development starts at embryonic day E10.5, corresponding to week 6.5 to 7 in human embryos. ? [2],? ? [3] Endothelial cells of the anterior cardinal vein give rise to the lymphatic primordia, which subsequently form the first primitive lymphatic structures termed lymph sacs. Despite interspecies variabilities of these primordia, the jugular region is generally accepted to be the site of lymphatic induction, ? [4] and mammalian embryos exhibit eight lymph sacs ( ? Fig. 1.1a,b). ? [4],? ? [5] By the end of the 9th development week in humans, lymphatic vessels connect the lymph sacs. In the fetal period, the lymphatic system already exhibits the asymmetrical condition characteristic of the adult lymphatic system ( ? Fig. 1.1c). Fig. 1.1 Morphological development of the human lymphatic system. (a, b) Illustration of a 9-week-old embryo with a primitive lymphatic system. The paired jugular lymph sacs arise from the anterior cardinal veins. Other lymph sacs: Posterior (paired), subclavian (paired; extension of jugular sac), retroperitoneal, and cisterna chyli. Except for the cisterna chyli, the lymph sacs subsequently differentiate into primary lymph nodes. (c) Fetal lymphatic system with asymmetrical anatomy. The thoracic duct drains the majority of the body’s lymph into the venous system at the junction of the left internal jugular and subclavian vein. In contrast, the right lymphatic duct only drains the right arm, the upper thorax, and the right side of the face. (Reprinted with permission from Carlson BM. Cardiovascular system. In: Human Embryology and Developmental Biology. 5th ed. Philadelphia: Saunders, 2014.) More than 100 years ago, the American anatomist Florence Sabin introduced the now widely accepted centrifugal theory of lymphatic development. ? [6] She based her theory upon ink-injection experiments in pig embryos and suggested that the peripheral lymphatic system arises from the primary lymph sacs. Then it would spread to the surrounding tissues and organs by endothelial sprouting, where local capillaries are formed. However, in 1910, Huntington and McClure suggested a contradictory centripetal theory, stating that lymphatic vessels arise from peripheral mesenchymal lymphatic endothelial cell (LEC) progenitors, called lymphangioblasts. ? [7] Expression studies of the lymphatic-specific marker vascular endothelial growth factor receptor 3 (VEGFR-3) and experiments in mice lacking the homeobox gene PROX1 (prospero homeobox protein 1) confirmed the venous origin of lymphatic vessels. ? [8],? ? [9] Importantly, in PROX1 -/- knockout mice, budding and sprouting of LEC progenitors is arrested without affecting the vasculature of blood vessel development. ? [9] These landmark studies led to the proposal of a stepwise model for the development of the lymphatic vasculature in mammals. ? [2],? ? [10],? ? [11] LEC competence of endothelial progenitor cells in the cardinal veins is achieved around E9.0 by PROX1 expression under the control of the transcription factor gene Sox18 (sex determining region Y box 18). ? [12] Under the influence of the lymphatic master-regulator gene PROX1, the endothelial progenitors undergo LEC commitment and start budding from the cardinal veins at approximately E10.5. ? [11] After commitment, cells may give rise to a particular cell type or structure, depending on the surrounding tissue. ? [2] Lymphatic vessel sprouting from the embryonic veins is guided by a graded mesenchymal expression of the VEGFR-3 ligand vascular endothelial growth factor C (VEGF-C). Paracrine VEGF-C signaling is crucial for the migration and survival of PROX1-expressing cells from the cardinal veins and for the subsequent formation of lymph sacs. ? [13] Furthermore, as LEC progenitor cells bud from the embryonic veins into the surrounding mesenchymal tissue, they begin expressing the lymphatic marker podoplanin, indicating lymphatic differentiation and maturation. ? [14] At around E11.5, PROX1+/VEGFR-3+/podoplanin+ differentiating LECs migrate in interconnected cell groups into the surrounding mesenchyme to form large lymph sacs. ? [11] Even though a major part of the lymphatic vasculature develops in a centrifugal manner through lymphangiogenesis (i.e., the growth of new lymphatic vessels from pre-existing capillaries), a dual origin of the lymphatic vasculature has been demonstrated in grafting experiments. ? [15] This study revealed that the avian lymphatic vasculature possesses both venous and mesenchymal cell contributions. The unequivocal proof of this dual origin came with recent genetic tracing studies in mice, demonstrating that both venous and nonvenous LECs participate in the development of lymphatic vessels. ? [16],? ? [17] LECs were initially observed as isolated cell clusters separate from the sprouting lymphovascular front which subsequently coalesced to form vessels through the process of lymphovasculogenesis. ? [17],? ? [18] After the establishment of the primitive lymphatic network from E14.5 onward, the lymphatic vessels undergo maturation and remodeling to form a hierarchical tree, characterized by lymphatic capillaries, precollectors, and collecting vessels. ? [18] Finally, the collecting vessels form lymphatic valves, recruit smooth muscle cells (SMCs), and deposit basement membrane. ? [11],? ? [18] 1.2 Anatomy of the Lymphatic System
Hiroo Suami Italian anatomist Gasparo Aselli is credited with the discovery of the lymphatic system in 1622. ? [19] While dissecting live canines, he chanced upon white cords in the mesentery and concluded that these structures were a new anatomic feature related to the absorption of nutrients. To further investigate that new structure, the mercury injection method developed by Anton Nuck was used as the standard technique in the study of cadaver models between the 17th and 20th centuries. ? [20] Our current anatomical knowledge about the lymphatic system is largely based on the findings that are generated by using the mercury method. However, this method fell out of favor because of the toxicity of mercury and anatomical studies using adult cadavers eventually ceased. A new, safer technique to identify the lymphatics in a cadaver was developed by Hiroo Suami, using hydrogen peroxide to inflate the lymphatic vessel, after which microscope manipulation was used to inject a contrast medium directly into the vessel via needle to allow radiographic demonstration. ? [21] A further modification was the application of indocyanine green (ICG) lymphangiography to map the superficial lymphatic collectors prior to dissection. ? [22] These new techniques have allowed us to conduct further anatomical studies of the lymphatics. Precise anatomical knowledge about the normal lymphatics is crucially important because it provides the baseline information required to identify the anatomical changes...
