LYMPHOSCINTIGRAPHY FOR NONINVASIVE LONG-TERM FOLLOW-UP OF THE FUNCTIONAL OUTCOME IN PATIENTS WITH AUTOLOGOUS LYMPH VESSEL TRANSPLANTATION

Aim: Autologous lymph vessel transplantation significantly improves th e lymphdrainage in patients with primary and secondary lymphedema. The aim of the present study was to answer the question, whether scintigr aphic long-term follow up and semiquantitative evaluation of lymphatic flow could prove the persisting success of this sophisticated microsu rgical technique. Methods: in this study visual and semiquantitative l ymphoscintigraphy was used to prove the function of lymphatic vessel g rafts in 20 patients (17 females, 3 males) comparing a preoperative ba seline study with postoperative follow up investigations for a period of 7 years. The reason for microsurgical lymph vessel transplantation was in 4 patients a primary and in 16 patients a secondary lymphedema. In 12 cases the transplantation site was at the upper extremity, in 8 cases at the lower limb. Results: In 17/20 patients lymphatic functio n significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvem ent of lymph drainage and decrease of a numeric transportindex. In 5 c ases the vessel graft could be directly visualized. In these patients with scintigraphic visualization of the vessel graft the transportinde x decreases to a significantly greater extent compared to the preopera tive baseline study. Only 3 patients did not benefit from microsurgica l treatment. Conclusion: Lymphoscintigraphy combined with semiquantita tive estimation of lymphatic transport kinetics has shown to be an eas y, reliable and readily available technique to assess lymphatic functi on before and after autologous lymph vessel transplantation. Thus, the method is not only helpful in planning microsurgical treatment but al so in monitoring the postoperative improvement of lymph drainage. Pati ents with scintigraphic visualization of the vessel graft showed a sig nificant better postoperative outcome than those without. The scintigr aphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding to lymph drainage.