Ozturk, C.N., Ozturk, C., Glasgow, M., Platek, M., Ashary, Z., Kuhn, J., . . . Gurunluoglu, R. (2016). Free vascularized lymph node transfer for treatment of lymphedema: A systematic evidence based review. Journal of Plastic, Reconstructive and Aesthetic Surgery, 69, 1234–1247. 

DOI Link

Purpose

STUDY PURPOSE: To review current research of free vascularized lymph node transfer (VLNT) for the treatment of lymphedema

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, CENTRAL electronic databases
 
YEARS INCLUDED: 1980 to May 1, 2015
 
INCLUSION CRITERIA: English language; VNLT only; could be used on upper or lower extremity lymphedema; more than five participants in each study; the studies were living human participants; in addition, the reviewers read the study references.  
 
EXCLUSION CRITERIA: Cadaver and animal studies

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 831
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Four authors participated in the review and ranking of the articles selection. The American Society of Plastic Surgeons (ASPS) has a checklist of guidelines, which includes a rigorous process to eliminate bias in selection for bias in selection. Finally, the ASPS has a level of evidence scale, and rankings were applied to each of the studies.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 18
  • TOTAL PATIENTS INCLUDED IN REVIEW = 305 patients, 309 limbs and 316 flaps
  • SAMPLE RANGE ACROSS STUDIES: Participants aged 13–80 years, 195 upper limbs and 114 lower. Secondary lymphedema was the leading cause of LE. Limb size determination varied. The duration of lymphedema varied from 3 months to 26 years. The average duration of lymphedema was greater than 24 years. Postoperative follow-up ranged from 2 to 132 months. 
  • KEY SAMPLE CHARACTERISTICS: Level of evidence studies: 3 were level II, 13 were level III, and 2 were level IV. None of the studies were ranked I or high quality.

Phase of Care and Clinical Applications

PHASE OF CARE: Pre- and postoperative VLNT
 
APPLICATIONS: Elder care

Results

  • Outcomes varied because evaluation of reduction was not consistent across studies.  
  • Circumferential measurement reduction: Ninety-one percent showed postoperative improvement.  
  • Lymphangioscintigraphy/lymphangiography: Sixty percent improved flow with moderate to significant improvement.  
  • Patient satisfaction: All but seven patients stated improvement and surgery satisfaction.
 

Conclusions

The findings suggest that the use of VLNT may be helpful in reducing lymphedema. Larger studies with standardized measurements are needed to create a stronger body of research to fully evaluate this surgical procedure.

Limitations

  • Limited number of studies included
  • Low sample sizes
  • The need to evaluate same lymphedema types, primary versus secondary, radiation, and no radiation is needed.  
  • All lymphedemas are not the same.

Nursing Implications

Limited evidence supports surgical interventions to manage lymphedema. However, the studies being conducted, although scant, do have potential, but outcomes vary presently.

Legacy ID

6553