Autologous Lymph Node-adipose Tissue Transplantation To Cure Upper Limb Lymphedema After Axillary Lymph Node Dissections: An Experimental Study

Upper limb lymphedema is one of the most frequent complications after axillary lymph node dissections. There have been no effective therapeutic measures available for upper limb lymphedema nowadays because of its trait of vicious cycle. It is agreed that to build a better connection between functional tissue with lymph nodes inside and lymphatic return deficiency areas to rebuild a lymph circulation is a fundamental method treating lymphedema. Some researchers have found that the transplantation of lymph nodes with blood vessels can keep their structural and functional integrity; lymphatic vessels can spontaneously recover their continuity by their regeneration capacity after transplantation. In order to investigate the feasibility and the effect of the technique in the treatment of lymphedema, we performed a preliminary experimental study on autologous lymph node-adipose tissue transplantation.1. Comparative study of animal models of upper limb lymphedema established using different methodsObjective: To search for methods for establishing animal models of upper limb lymphedema with good stability and high success rate. Methods: Models were established by using subcutaneous tissue circumcise, radiation exposure, and combined method (subcutaneous tissue circumcise plus radiation exposure) to make upper limb lymphedema on 18 animals. Then the success rate, stability and lymphedema degrees of the models by the three methods were compared. Results: Of the 18 animals, 14 survived for 18 weeks after operations. Seven animal models were successfully established. The success rate of model building was 100 % (4/4) for the combined method, 75 % (3/4) for the subcutaneous tissue circumcise method, and 0 % (0/6) for the radiation exposure method. We found that the animal models of upper limb lymphedema established by the subcutaneous tissue circumcise method and the combined method were stable, and could be kept for long time. The combined method has better effect on building lymphedema models than the subcutaneous tissues circumcise method. The models built by radiation exposure method could not keep lymphedema for long time. Conclusions: Animal models of upper limb lymphedema can be successfully built by the subcutaneous tissue circumcise method and the combined method.2. Study on the feasibility of autologous lymph node-adipose tissue transplantationObjective: To study the feasibility of autologous lymph node-adipose tissue transplantation. Methods: Japanese White Rabbits were used for the study. Autologous lymph node-adipose tissue from inguinal region with blood vessels of the animals were collected and transplanted into the homolateral axillary fossa region where lymph nodes were dissected and blood supply was rebuilt using microsurgery anastomosis. The graft survival, changes in limbs volume, radionuclide imaging and histology were observed to comprehend whether the transplants could rebuild the devastated lymph circulation. Results: We performed 24 autologous lymph node-adipose tissue transplantations in 24 rabbits, with 16 weeks of observation after operation. The graft survival rate was 66.7 % (16/24). The success rate of rebuilt lymph circulation in the survival animals was 81.3% (13/16). Histological observations showed normal lymphatic vessels and lymph node structures in the transplants. No obvious lymphedema phenomenon occurred both in forelimbs and hindlimbs of the experimental animals. Conclusions: Autologous lymph node-adipose tissue transplantation can rebuild lymph circulation, and is safe and feasible.3. Observation of the treatment effect of the autologous lymph node-adipose tissue transplantation on the limb lymphedemaObjective:To investigate the treatment effect of the autologous lymph node-adipose tissue transplantation on limb lymphedema. Methods: The 7 rabbit models of upper limb lymphedema were used as the experiment objects. The autologous lymph node-adipose tissue from the inguinal region with blood vessels were obtained and transplanted into the edematous axillary fossa and blood supply was rebuilt by microsurgery. The changes in limbs volume and radionuclide imaging were observed to judge the treatment effect of the transplantation on the upper limb lymphedema. Results: We performed the transplantation in 5 rabbits (the experimental group) and took the rest 2 as the controls. 10 weeks after operation 2 rabbits survived in the experimental group, the volume of the upper limbs in this group decreased 25.9% and 44.4%, the volume gap between the upper limbs in the control group kept steady. All axillary lymph nodes could be tracked by radionuclide imaging in the experimental group and no axillary lymph node was tracked in the control group. Conclusions: Autologous lymph node-adipose tissue transplantation can obtain short-term effect in the treatment of limb lymphedema; its long-term effect needs further studies.