{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:36:40Z","timestamp":1791999400718,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T00:00:00Z","timestamp":1546560000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All flaps survived. The mean follow\u2010up period was 14.2 months (range, 12\u201019). The mean circumference reduction rate was 74.5%\u2009\u00b1\u20096.9% for the upper limb and 68.0%\u2009\u00b1\u20094.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7\u2010fold quality\u2010of\u2010life improvement (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients\u2019 quality of life in the advanced stages of lymphedema.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25360","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T19:27:50Z","timestamp":1546630070000},"page":"439-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema"],"prefix":"10.1002","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4646-2676","authenticated-orcid":false,"given":"Pedro","family":"Ciudad","sequence":"first","affiliation":[{"name":"Department of Plastic and Burn Surgery Arzobispo Loayza National Hospital Lima Peru"},{"name":"Department of Plastic and Reconstructive Surgery National Cancer Institute of Peru (INEN) Lima Peru"},{"name":"Department of Plastic and Reconstructive Surgery China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar J","family":"Manrique","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kian","family":"Adabi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony Chieh\u2010Ting","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0242-0941","authenticated-orcid":false,"given":"Mouchammed","family":"Agko","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Medical College of Georgia Augusta University Augusta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Trignano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Ling","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung\u2010Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Salgado","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive and Aesthetic Surgery University of Miami Miller School of Medicine Miami Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,4]]},"reference":[{"key":"e_1_2_8_1_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-2017-4"},{"key":"e_1_2_8_1_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002683"},{"key":"e_1_2_8_1_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30246"},{"key":"e_1_2_8_1_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182a4d626"},{"key":"e_1_2_8_1_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22272"},{"key":"e_1_2_8_1_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30079"},{"key":"e_1_2_8_1_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24730"},{"key":"e_1_2_8_1_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2012.08.002"},{"key":"e_1_2_8_1_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31819e6529"},{"key":"e_1_2_8_1_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2012.04.017"},{"key":"e_1_2_8_1_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31827fb39e"},{"key":"e_1_2_8_1_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1372482"},{"key":"e_1_2_8_1_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22344"},{"key":"e_1_2_8_1_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30037"},{"key":"e_1_2_8_1_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22450"},{"key":"e_1_2_8_1_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30134"},{"key":"e_1_2_8_1_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30168"},{"key":"e_1_2_8_1_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534734612438550"},{"key":"e_1_2_8_1_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000472450.00980.04"},{"key":"e_1_2_8_1_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31818d45aa"},{"key":"e_1_2_8_1_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31802ca54c"},{"key":"e_1_2_8_1_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22235"},{"key":"e_1_2_8_1_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000295"},{"key":"e_1_2_8_1_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-015-1736-3"},{"key":"e_1_2_8_1_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24969"},{"key":"e_1_2_8_1_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24349"},{"key":"e_1_2_8_1_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22280"},{"key":"e_1_2_8_1_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30196"},{"key":"e_1_2_8_1_30_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2016.43.2.210"},{"key":"e_1_2_8_1_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30168"},{"key":"e_1_2_8_1_32_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2015.42.5.650"},{"key":"e_1_2_8_1_33_1","first-page":"84","article-title":"The diagnosis and treatment of peripheral lymphedema. Consensus document of the international society of lymphology","volume":"36","author":"International Society of Lymphology","year":"2003","journal-title":"Lymphology"},{"issue":"1","key":"e_1_2_8_1_34_1","first-page":"26","article-title":"A quality of life measure for limb lymphoedema (lymqol)","volume":"5","author":"Keeley V","year":"2010","journal-title":"J Lymph"},{"key":"e_1_2_8_1_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623884"},{"key":"e_1_2_8_1_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.08.011"},{"key":"e_1_2_8_1_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.GOX.0000526267.02633.e7"},{"key":"e_1_2_8_1_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000513"},{"key":"e_1_2_8_1_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002169"},{"key":"e_1_2_8_1_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182426757"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjso.25360","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.25360","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T10:13:16Z","timestamp":1694686396000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.25360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,4]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1002\/jso.25360"],"URL":"https:\/\/doi.org\/10.1002\/jso.25360","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,4]]},"assertion":[{"value":"2018-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}