{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T19:36:01Z","timestamp":1774726561089,"version":"3.50.1"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund Das sekund\u00e4re Lymph\u00f6dem (SL) stellt eine der h\u00e4ufigsten und\n                    zugleich bedeutsamsten Folgen und Komplikation der modernen onkologischen\n                    Therapie dar. Obwohl eine gr\u00fcndliche Anamnese und k\u00f6rperlicher Untersuchung f\u00fcr\n                    den Verdacht ausreichen, ist eine funktionelle Bildgebung des Lymphsystems f\u00fcr\n                    die gezielte Diagnose und Ermittlung des Schweregrads essenziell. Hierf\u00fcr wurden\n                    in den letzten Jahren Techniken wie die MR-und die ICG-Lymphographie sowie die\n                    ultrahochfrequenten Ultraschalluntersuchungen entwickelt und validiert. Die\n                    selektive Anwendung dieser Techniken hat die individualisierte\n                    Indikationsstellung und erfolgreiche stadienabh\u00e4ngige Behandlung mit den\n                    (super-) mikrochirurgischen Techniken zur Wiederherstellung des regionalen\n                    Lymphabflusses im Kontext einer intensivierten konservativen Therapie erst\n                    m\u00f6glich gemacht.<\/jats:p><jats:p>\n          Methode Systematischer Review der Literatur zur Diagnose und Therapie des\n                    SL mit anschlie\u00dfender Analyse und Klassifikation der Ergebnisse in Evidenzlevel\n                    gem\u00e4\u00df Oxford Centre for Evidence-Based Medicine sowie gem\u00e4\u00df der GRADE Skala.<\/jats:p><jats:p>\n          Ergebnisse Zur etablierten und validierten Diagnostik des SL geh\u00f6ren\n                    Bildgebungen (ICG Fluoreszenzlymphographie, MR-Lymphographie und Tc-99\n                    Funktionslymphszintigraphie) bei klinischem Verdacht und Hochrisikopatienten.\n                    Komplexe physikalische Entstauungstherapie (KPE) ist der Physiotherapie oder\n                    Kompression allein \u00fcberlegen. Die (Super-)Mikrochirurgie des SL erm\u00f6glicht eine\n                    postoperative Reduktion der Frequenz der KPE, Reduktion von Erysipelraten,\n                    Volumenreduktion der lymphomat\u00f6sen Extremit\u00e4t und bei prophylaktischer\n                    Durchf\u00fchrung eine geringere Inzidenz des SL. Saugungsverfahren k\u00f6nnen\n                    langfristig stabile Umfangsreduktionen und eine Verbesserung der Lebensqualit\u00e4t\n                    erzeugen.<\/jats:p><jats:p>\n          Schlussfolgerung Patienten mit SL profitieren von einer konservativen\n                    Therapie mit regelm\u00e4\u00dfiger Reevaluation. Hochrisikopatienten f\u00fcr ein SL oder\n                    Patienten mit einer klinischen Verschlechterung oder gleichbleibendem\n                    Leidensdruck unter leitliniengerechter konservativer Therapie k\u00f6nnen von\n                    (super-)mikrochirurgischen Therapien nach individualisierter Funktionsdiagnostik\n                    des Lymphsystems profitieren. Exzisionale Dermolipektomien oder\n                    Lympholiposuktionen sind f\u00fcr fortgeschrittene und therapierefrakt\u00e4re Stadien\n                    verf\u00fcgbar und wirksam.<\/jats:p>","DOI":"10.1055\/a-2322-1325","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T22:54:50Z","timestamp":1719269690000},"page":"291-300","source":"Crossref","is-referenced-by-count":6,"title":["Evidenz der modernen Diagnostik, der konservativen und chirurgischen\n                    Therapie des sekund\u00e4ren Lymph\u00f6dems"],"prefix":"10.1055","volume":"56","author":[{"given":"Patrick","family":"Will","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische und Handchirurgie, Universit\u00e4tsklinikum Carl\n                    Gustav Carus, Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Dragu","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische und Handchirurgie, Universit\u00e4tsklinikum Carl\n                    Gustav Carus, Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Zuther","sequence":"additional","affiliation":[{"name":"Lymphatic Unit, Academy of Lymphatic Studies, Sebastian, United\n                    States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Heil","sequence":"additional","affiliation":[{"name":"Brustzentrum Heidelberg, St. Elisabeth Klinik, Heidelberg,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"De-Hua","family":"Chang","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr diagnostische und interventionelle Radiologie,\n                    Universit\u00e4tsKlinikum Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrg","family":"Traber","sequence":"additional","affiliation":[{"name":"Gef\u00e4\u00dfchirurgische Klinik, Venenklinik Bellvue Kreuzlingen, Kreuzlingen,\n                    Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Hirche","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische Chirurgie, Hand- und Rekonstruktive\n                    Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Unfallklinik Frankfurt\n                    am Main, Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"5138","DOI":"10.1002\/cncr.25458","article-title":"Lymphedema beyond breast cancer: A systematic review and meta-analysis of\n                    cancer-related secondary lymphedema","volume":"116","author":"J N Cormier","year":"2010","journal-title":"Cancer"},{"key":"ref2","first-page":"3","article-title":"The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of\n                    the International Society of Lymphology","volume":"53","author":"Executive Committee of the International Society of\n                            L","year":"2020","journal-title":"Lymphology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/j.1529-8019.2009.01271.x","article-title":"Filariasis: diagnosis and treatment","volume":"22","author":"N Mendoza","year":"2009","journal-title":"Dermatol Ther"},{"key":"ref5","first-page":"23","article-title":"FORTBILDUNG-Lymphodem-Das vernachlassigte Gefasssystem: 4, 5 Mill. 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