Lymphedema Complete Medical and Surgical Management,

1st Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/lymphedema-complete-medical-and-surgical-management-
1st-edition/

Click Download Now

 This book is dedicated to my wife, Gabrielle,
who, as always, is my staunch supporter

P.C.N.

•
This book is dedicated to my family
for their unconditional love and support,
which allowed me to achieve my professional dreams

J.M.
•

To my fantastic wife, loving family, and caring friends

for being there when I needed them,
and for their enduring enthusiasm and support

N.B.P.
•

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 5 5/29/2015 9:24:24 AM

 EXECUTIVE EDITOR Sue Hodgson
SENIOR PROJECT EDITING MANAGER Carolyn Reich
SENIOR DEVELOPMENTAL EDITOR Megan Fennell
GRAPHICS MANAGER Brett Stone
DIRECTOR OF ILLUSTRATION AND DESIGN Brenda Bunch
MANAGING EDITOR Suzanne Wakefield
PROJECT MANAGER Idelle Winer
PRODUCTION Chris Lane, Debra Clark, Susan Trail, Madonna Gauding
PROOFREADER Linda Maulin
INDEXER Matthew White

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 6 5/29/2015 9:24:25 AM

 C ontributors

Devisha Agarwal, MBBS (Std) Corinne Becker, MD

Medical Student, GSVM Medical College, Lecturer, Department of Thoracic Surgery,
Kanpur, Uttar Pradesh, India Hôpital Européen–Georges Pompidou; Surgeon,
American Hospital of Paris, Paris, France
Rajiv Agarwal, MCh, FRCS
Professor and Head, Department of Plastic Francesco Boccardo, MD, PhD
Surgery and Burns, Sanjay Gandhi Postgraduate Associate Professor of Surgery, Unit of Lymphatic
Institute of Medical Sciences, Lucknow-Uttar Surgery, Department of Surgery; Director, Clinic
Pradesh, India for Medical Oncology, IRCCS University Hospital
San Martino, National Institute for Cancer
Madhur Guruprasad Aggithaya, MD Research (IST), Genoa, Italy
Institute of Applied Dermatology, Kasaragod,
Kerala, India Håkan Brorson, MD, PhD
Associate Professor, Department of Clinical
Miguel Amore, MD, PhD, FACS Sciences, Lund University; Department of Plastic
Director of Vascular Anatomy Laboratory; and Reconstructive Surgery, Skåne University
III Chair of Anatomy, Department of Anatomy, Hospital, Malmö, Sweden; Professor, Esculera
Buenos Aires University; Surgical Staff, Unit of de Graduados, Asociación Médica Argentina,
Phlebology and Lymphology, Central Military Buenos Aires, Argentina
Hospital, Buenos Aires, Argentina
Kerstin Buttler, MD
Mauro Andrade, MD, PhD Professor, Institute of Anatomy and Cell Biology,
Associate Professor of Surgery, Department of University Medical Center Göttingen, Göttingen,
Surgery, University of São Paulo Medical School, Germany
São Paulo, Brazil
Corradino Campisi, MD, PhD, FACS
Jane M. Armer, PhD, RN, CLT, FAAN University Department of Surgery (DISC),
Professor, Sinclair School of Nursing, University Section of Lymphology and Microsurgery,
of Missouri; Director, Department of Nursing Operative Unit of Lymphatic Surgery, IRCCS
Research, Ellis Fischel Cancer Center; Director, University Hospital San Martino, National
American Lymphedema Framework Project, Institute for Cancer Research (IST), Genoa, Italy
Columbia, Missouri
Corrado Cesare Campisi, MD, PhD, RAS-ACS
Rüdiger G.H. Baumeister, MD, PhD Surgeon, Division of Plastic, Reconstructive
Professor, Former Head, Department of Surgery, and Aesthetic Surgery, Department of Surgery
Campus Grosshadern, Division of Plastic, (DISC), IRCCS University Hospital San Martino
Hand, and Micro-Surgery, Ludwig Maximilians (IST), Genoa; Surgeon, Division of Experimental
University; Consultant in Lymphology, and Microsurgery, Department of Surgery, IRCCS
Department of Surgery, Chirurgische Klinik San Matteo University Hospital Foundation,
München-Bogenhausen, Munich, Germany Pavia, Italy

vii

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 7 5/29/2015 9:24:25 AM

 viii Contributors

Marco Cardone, MD Etelka Földi, MD

Department of Rehabilitation Medicine, San Professor, Center for Lymphology, Földiklinik,
Giovanni Battista Hospital, Rome, Italy Hinterzarten-Baden-Württemberg, Germany

Manish C. Champaneria, MD Jason C. Gardenier, MD

Plastic and Reconstructive Surgeon, Department Research Fellow, Department of Surgery, Division
of Surgery, PeaceHealth Southwest Medical of Plastic and Reconstructive Surgery, Memorial
Center, Vancouver, Washington Sloan Kettering Cancer Center, New York, New
York
Janice N. Cormier, MD, MPH, FACS
Professor of Surgery, Department of Surgical Swapna Ghanta, MD
Oncology, University of Texas M.D. Anderson Research Fellow, Department of Surgery, Division
Cancer Center, Houston, Texas of Plastic and Reconstructive Surgery, Memorial
Sloan Kettering Cancer Center, New York, New
Kate D. Cromwell, MS, MPH York
Clinical Studies Coordinator, Department of
Surgical Oncology, University of Texas M.D. Kristiana Gordon, MBBS, MRCP, CLT, MD (Res)
Anderson Cancer Center, Houston, Texas Honorary Senior Lecturer, Cardiovascular and
Cell Sciences Research Institute, St. George’s
Daniel A. Cuzzone, MD University of London; Consultant, Department of
Resident Research Fellow, Department of Surgery, Dermatology and Lymphovascular Medicine,
Division of Plastic and Reconstructive Surgery, St. George’s Hospital, London, United Kingdom
Memorial Sloan Kettering Cancer Center;
Resident, Department of Plastic Surgery, Institute Arin K. Greene, MD, MMSc
of Reconstructive Plastic Surgery, New York Co-director, Lymphedema Program, Department
University Langone Medical Center, New York, of Plastic and Oral Surgery, Boston Children’s
New York Hospital; Associate Professor of Surgery, Harvard
Medical School, Boston, Massachusetts
Joseph H. Dayan, MD
Assistant Professor, Department of Surgery, David G. Hancock, PhD
Division of Plastic and Reconstructive Surgery, Lymphoedema Research Unit, Department of
Memorial Sloan Kettering Cancer Center, New Surgery, Flinders University School of Medicine,
York, New York Bedford Park, Adelaide, South Australia,
Australia
Yener Demirtas, MD
Associate Professor, Lymphest Plastic Surgery Mitsunobu Harima, MD
Clinic, Istanbul, Turkey Department of Clinical Pharmacology, Niigata
University of Pharmacy and Applied Life
Audra A. Duncan, MD Sciences, Niigata, Japan
Professor of Surgery, Mayo Clinic, Rochester,
Minnesota Jennifer M. Hulett, PhD(c), APRN, FNP-BC
Doctoral Candidate, Sinclair School of Nursing,
Alessandro Fiorentino, MD University of Missouri, Columbia, Missouri
Department of Vascular Surgery, Università
Cattolica del Sacro Cuore, Policlinico Agostino Swetha Kambhampati, MD
Gemelli, Rome, Italy Resident in Internal Medicine, The Johns
Hopkins Hospital, Baltimore, Maryland

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 8 5/29/2015 9:24:25 AM

 Contributors ix

Vaughan Keeley, PhD, FRCP Jaume Masia, MD, PhD

Honorary Associate Professor, Department of Chief, Plastic Surgery Department, Hospital
Palliative Medicine, University of Nottingham de la Santa Creu i Sant Pau; Professor of Plastic
School of Medicine, Nottingham; Consultant Surgery, School of Medicine at Universitat
in Palliative Medicine/Lymphoedema, Derby Autònoma de Barcelona; Director, Microsurgery
Teaching Hospitals, NHS Foundation Trust, and Breast Reconstructive Unit, Clinica Planas,
Derby, United Kingdom Barcelona, Spain

Maija Kolehmainen, MD Babak J. Mehrara, MD, FACS

Department of Plastic Surgery, Helsinki Director, Lymphatic Research Laboratory,
University Central Hospital, Helsinki, Finland Department of Surgery, Division of Plastic
and Reconstructive Surgery, Memorial Sloan
Isao Koshima, MD Kettering Cancer Center; Professor of Plastic
Professor and Chief, Department of Plastic, Surgery, Weill Cornell University Medical Center,
Reconstructive and Aesthetic Surgery, The New York, New York
University of Tokyo Hospital, Tokyo, Japan
Diego Mercado, MD
James Laredo, MD, PhD, FACS Institute for Immunological Research, University
Associate Professor of Surgery, Department of Cartagena, Cartagena, Colombia
of Surgery, Division of Vascular Surgery,
George Washington University Medical Center, Sandro Michelini, MD
Washington, DC Chief of Vascular Rehabilitation, San Giovanni
Battista Hospital; Past President, European
Byung-Boong Lee, MD, PhD, FACS Society of Lymphology; President, Italian
Professor of Surgery, Department of Surgery, Lymphoedema Framework; President-Elect,
George Washington University, Washington, DC Italian Society of Phlebolymphology, Rome, Italy

Joshua Levine, MD Geraldine Mitchell, PhD

Director of Surgical Services, Department of Faculty of Health Sciences, Australian Catholic
Plastic and Reconstructive Surgery, New York University, Melbourne, Victoria, Australia
Eye and Ear Infirmary of Mount Sinai, New York,
New York Lee M. Mitsumori, MD, MSBE
Affiliate Associate Professor, Department of
Ningfei Liu, MD, PhD Radiology, University of Washington, Seattle,
Professor of Plastic Surgery, Department of Washington; Physician, Department of Radiology,
Plastic and Reconstructive Surgery, Shanghai Straub Clinic and Hospital, Honolulu, Hawaii
Ninth People’s Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China Christine Moffatt, CBE, FRCN, PhD, MA,
RGN, DN
Reid A. Maclellan, MD, MMSc Professor of Clinical Nursing Research, School of
Instructor of Surgery, Department of Plastic and Health Sciences, The University of Nottingham,
Oral Surgery, Lymphedema Program, Boston Nottingham, United Kingdom
Children’s Hospital, Harvard Medical School,
Boston, Massachusetts Susie Murray MA, RGN, RHV (retired)
Project Manager, International Lymphoedema
Gurusamy Manokaran, MD Framework, London, United Kingdom
Senior Consultant Plastic Surgeon and
Lymphologist, Apollo Hospital, Chennai, India S.R. Narahari, MD, DVD
Chair and Director, Institute of Applied
Dermatology, Kasaragod, Kerala, India

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 9 5/29/2015 9:24:25 AM

 x Contributors

Mitsunaga Narushima, MD Stanley Rockson, MD, FACP, FACC

Assistant Professor, Department of Plastic and Allan and Tina Neill Professor of Lymphatic
Reconstructive Surgery, University of Tokyo, Research and Medicine, Division of
Tokyo, Japan Cardiovascular Medicine, Stanford University
School of Medicine; Director, Stanford Center
Peter C. Neligan, MB, FRCS(I), FRCSC, FACS for Lymphatic and Venous Disorders, Stanford
Professor of Surgery, Division of Plastic Surgery, University Hospital and Clinics, Stanford,
University of Washington, Seattle, Washington California

Waldemar Olszewski, MD, PhD Merrick I. Ross, MD

Professor of Surgery, Medical Research Center, Chief, Melanoma Section, Charles C. McBride
Polish Academy of Sciences, Central Clinical Distinguished Professorship in Surgical
Hospital, Ministry of Internal Affairs, Warsaw, Oncology, Department of Surgical Oncology,
Poland Division of Surgery, University of Texas M.D.
Anderson Cancer Center, Houston, Texas
Pia Ostergaard, PhD
Senior Research Fellow, Lymphovascular Melissa Ryan, PhD, PgDips
Research Unit, Division of Cardiovascular and Clinical Psychologist, Department of Surgery,
Cell Sciences, St. George’s University of London, Section of Lymphology and Microsurgery,
London, United Kingdom Operative Unit of Lymphatic Surgery, IRCCS
University Hospital San Martino, Genoa, Italy
Wei-Ren Pan, MD, PhD
Professor, Department of Anatomy, Xuzhou Terence Ryan, DM, FRCP, KStJ
Medical College, Xuzhou, Jiangsu, China Emeritus Professor, Department of Dermatology,
Green Templeton College, Oxford University,
Cristobal Miguel Papendieck, MD, FACS Oxford, United Kingdom
Department of Pediatric Surgery, Deutsches
Hospital, Buenos Aires, Argentina Ira L. Savetsky, MD
Research Fellow, Department of Surgery, Division
Gisela Romina Pattarone, MD of Plastic and Reconstructive Surgery, Memorial
Department of Medicine, University of Buenos Sloan Kettering Cancer Center; Resident,
Aires School of Medicine, Buenos Aires, Department of Surgery, New York University
Argentina Langone Medical Center, New York, New York

Anthony Penington, MB, BS, FRACS Ramin Shayan, MB, BS, PhD, FRACS
Jigsaw Professor of Pediatric and Maxillofacial Jack Brockhoff Reconstructive Plastic Surgery
Surgery, The Royal Children’s Hospital, Research Unit, Department of Anatomy and Cell
Melbourne, Victoria, Australia Biology, The University of Melbourne, Parkville,
Victoria, Australia
Neil B. Piller, BS, PhD, FACP
Professor and Director, Lymphoedema Research Mark L. Smith, MD
Unit, Department of Surgery, Flinders University Division of Plastic and Reconstructive Surgery,
School of Medicine, Bedford Park, Adelaide, Department of Surgery, Beth Israel Medical
South Australia, Australia Center, New York, New York

Bob R. Stewart, EdD

Professor Emeritus, College of Education;
Adjunct Professor, Sinclair School of Nursing,
University of Missouri, Columbia, Missouri

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 10 5/29/2015 9:24:25 AM

 Contributors xi

Sinikka Suominen, MD, PhD Kathleen Wang, B. Psych (Hon), MD candidate

Adjunct Professor and Department Chief, Clinic Research Officer, Lymphoedema Research Unit,
of Plastic Surgery, Helsinki University Hospital, Flinders University School of Medicine, Bedford
Helsinki, Finland Park, Adelaide, South Australia, Australia

Lucia Tapia, MD Jörg Wilting, MD

Department of Medicine, University of Buenos Professor, Institute of Anatomy and Cell Biology,
Aires School of Medicine, Buenos Aires, Göttingen University Medical Center, Göttingen,
Argentina Germany

Jeremy S. Torrisi, BA Takumi Yamamoto, MD

Research Assistant, Department of Surgery, Department of Plastic and Reconstructive
Division of Plastic and Reconstructive Surgery, Surgery, University of Tokyo, Tokyo, Japan
Memorial Sloan Kettering Cancer Center, New
York, New York Baris Yigit, MD
Associate Professor, Düzce University,
B. Vijaya, MD Department of Plastic Surgery, Düzce, Turkey
Professor of Pathology, JSS Medical College of JSS
University, Mysore, Karnataka, India Marzanna T. Zaleska, MD
Medical Research Center, Polish Academy of
Ausanee Wanchai, PhD, RN Sciences, Department of Vascular and General
Nursing Instructor, Deputy Director for Surgery and Radiology, Central Clinical Hospital,
Academic Service and Research, Boromarajonani Ministry of Internal Affairs, Warsaw, Poland
College of Nursing, Buddhachinaraj Hospital,
Phitsanulok, Thailand

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 11 5/29/2015 9:24:25 AM

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 12 5/29/2015 9:24:25 AM
 P reface

Lymphedema is a significant global problem, and its incidence will increase with a population that
is living longer. In addition, because of the interrelationship between the lymphatic system and
adipose tissue, the obesity epidemic has led to a rapid rise in this complication. Lymphedema is
unique in that it is the end result of myriad conditions affecting the blood, tissue, and lymphatic
system, ranging from congenital anomalies to parasitic infestations to postcancer treatment se-
quelae and soft tissue trauma. Although we know a great deal about lymphedema in terms of its
causes and consequences, we still know far too little to be able to propose a comprehensive tar-
geted and sequenced treatment plan. So much work remains to be undertaken, and our knowl-
edge base must be deepened and widened in this area.

Lymphedema has been one of those conditions that most people do not want to acknowledge or
treat. This is probably because we do not yet have a strong, standardized assessment regimen, an
ability (and often willingness) to undertake an accurate differential diagnosis (separating lymph-
edema from other reasons for swelling), and a good objective knowledge of how best to sequence
and target treatment. We still lack strong evidence as to which treatments are best, as well as an
uncertainty about when to move from conservative to surgical strategies when conservative ap-
proaches fail, or even whether it is better to start with a surgical intervention (such as anastomo-
ses) in the first place.

Fortunately, there is a core group of practitioners who maintain their interest in this broad-based
disorder, and in recent years, surgeons have joined them in recognition that surgical options after
the failure of conservative treatment (or at times surgery may be added to conservative treatment
early in the development of lymphedema) can offer improved management of the condition and
thus improved quality of life for the at-risk group as well as those who already have lymphedema.
In this book we highlight the surgical group, who have added a new dimension to our approach.

We have tried to be rational, and where possible, evidence-based in our approach to lymphedema,
although we acknowledge that at times the evidence is not strong or is based only on clinical judg-
ments (the experience of experts). The fact that the symptoms and consequences of lymphedema
often have a lifelong impact on the quality of survival of our patients must be dealt with in a bal-
anced and holistic manner.

For that reason, the book is divided into several parts. We have recruited the brightest minds and
those with the greatest experience and expertise in the field, and put together a comprehensive,
balanced, and considered approach to the condition. Lymphologists, therapists, and surgeons were
asked to give their accurate (evidence-based and knowledge-based) appraisal of the problem. The
result is a comprehensive catalog of where we are, what we know, and where we should go.

xiii

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 13 5/29/2015 9:24:25 AM

 xiv Preface

Part I outlines current concepts as a place to start. In Part II we discuss the anatomy and physiol-
ogy of lymphedema and explore lymphangiogenesis. Embryology is also important to our under-
standing of the lymphatic system, particularly to our comprehension of lymphatic malformations.
Furthermore, as our genetic knowledge deepens, additional genetic abnormalities are recognized.
Here we examine their impact on these patients and their families. Finally, in this section the role
of the lymphatics is addressed, as well as the general and specific aspects of immune system func-
tion, and the consequences when it fails.

Part III examines in detail the pathophysiology of both primary and secondary lymphedema. Fila-
riasis, the most common worldwide cause of lymphedema with over 1.4 billion at risk, is covered
in a separate chapter. We also examine the impact of venous failure on lymphedema and how this
and an often combined lymphatic failure affects adults as well as children. We tackle risk factors
for lymphedema in patients with breast and other cancers and examine the role of sentinel node
sampling in their management.

Part IV emphasizes the fact that accurate diagnosis of lymphedema is vitally important; this is dealt
with in its own section. Internationally accepted classification recommendations for lymphedema are
discussed, because these systems offer a very useful tool to categorize clinical findings. The various
assessment techniques, measurement options, imaging methods, and staging systems are reviewed,
as well as lymph pressure and flow measurement using traditional and new techniques.

We have tried to include all aspects of treatment. In Part V seventeen chapters have been assembled
to cover every facet. These chapters not only include conservative approaches but also all of the sur-
gical approaches currently being used around the world, together with recommendations for when
and where they might be appropriate. One of the most important points emphasized in this section is
how to recognize and treat the complications and comorbidities that are inevitable with this disease.

In Part VI the book concludes with a review and critical appraisal of current research. This inevi-
tably leads to a discussion of future directions. As mentioned at the outset, so much is unknown
about lymphedema that there is a huge amount of work to be done. We explore several likely ap-
proaches that may be adopted. Lymphedema is presently of intense interest to investigators, and
much research is being done in many areas, including genetics, conservative treatment and man-
agement, and surgical approaches, as well as the best strategies for early detection of lymphatic
insufficiencies that can lead to lymphedema.

Predictably, much of the information in this book will change in the coming years as we learn
more and further understand the disease. However, it is our hope that this book will form the ba-
sis for new knowledge, enhance surgeons’ ability to explore innovative approaches, and lead all
to provide better outcomes for patients at risk for and with lymphedema.

Peter C. Neligan
Seattle, Washington
Jaume Masia
Barcelona, Spain
Neil B. Piller
Bedford Park, Adelaide, South Australia, Australia

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 14 5/29/2015 9:24:25 AM

 A cknowledgments

I would like first of all to acknowledge my two co-editors, Jaume and Neil, as well as the contrib-
uting authors who gave freely of their time and expertise to make this book possible. I am also
indebted to my residents and fellows for always keeping me on my toes. My partners at the Uni-
versity of Washington are always supportive and encouraging, and I am grateful to them for that.
It has been a pleasure working with the team at CRC Press led by Sue Hodgson, who, as always,
keeps the project going and is constantly available to help and advise. Megan Fennell has done
a stellar job, as has Idelle Winer. Brenda Brunch has directed the artwork, and Cassio Lynm has
worked tirelessly with the contributing authors to make the illustrations not only look great but
accurate. This book is a credit to all of them.

P.C.N.

There are many people to whom I am indebted for making this publication possible. My heartfelt
thanks to Peter and Neil for their expertise, enthusiasm, and honesty, which have been key fac-
tors in making this book a valuable resource for people wanting to learn more about lymphedema
and to advance its treatment. I am sincerely grateful to the many colleagues and friends for their
close collaboration and excellent contributions.

Also to be thanked are the teams at Sant Pau University Hospital and at Clinica Planas, associ-
ates, residents, fellows, nurses, and secretaries, and in particular, my lymphedema nurse, Patricia
Martinez, and my associate, Gemma Pons, for their constant concern and care for all our lymph-
edema patients.

I want to take this opportunity to express my appreciation to the CRC Press team. Their profes-
sionalism has been essential to the quality of this book. Sue Hodgson deserves special mention,
for without her experience and tenacity for excellence, the project would not have come together
within the assigned time frame.

And finally, I would like to extend a special thank you to everyone working in the field of lymph-
edema, for it is through the mutual sharing and exchange of knowledge that we will move forward
in optimizing the quality of life for our patients.

J.M.

xv

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 15 5/29/2015 9:24:26 AM

 xvi Acknowledgments

A plethora of people initiated and maintained my interest and enthusiasm for all things lym-
phologic, but there are four in particular to whom I am particularly indebted. These are Dr. John
Casley-Smith, originally from the Electron Optics Unit in the School of Medicine at the University
of Adelaide, who in the late 1960s introduced me to lymphedema and who taught me all I know
about the importance of the ultrastructure of the microcirculation and of the blood-tissue-lymph
system; Prof. Dr. Leo Clodius from the Plastische und Wiederherstellungs Chirurgie Department
of the Kantonsspital in Zurich, with whom I worked in 1975, and who first drew my attention to
the range of surgical treatments that could help lymphedema, taught me about surgical models
for lymphedema, and who in my view was an unacknowledged early leader in microsurgical in-
terventions for lymphedema; and Drs. Michael Földi and Etelka Földi, with whom I worked in
1977 and who made me aware of the deficits in our lymphatic and lymphedema knowledge, who
led our awareness and knowledge of how conservative treatment can make a difference, and who
made me think more critically about all we say and do regarding lymphedema.

N.B.P.

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 16 5/29/2015 9:24:26 AM

 C ontents

Part I Current Concepts in Lymphedema

1 Lymphedema: Lack of Solutions to a Clinical Problem 3
Manish C. Champaneria, Peter C. Neligan

2 Lymphedema and Its Impact on Quality of Life 25

Jane M. Armer, Jennifer M. Hulett, Janice N. Cormier, Bob R. Stewart,
Ausanee Wanchai, Kate D. Cromwell

3 Quality of Life Measurement Instruments 41

Vaughan Keeley

Part II Anatomy, Physiology, and Lymphangiogenesis

4 Embryology 53
Sandro Michelini, Miguel Amore, Lucia Tapia, Gisela Romina Pattarone, Diego Mercado,
Jeremy S. Torrisi, Ira L. Savetsky, Jason C. Gardenier, Babak J. Mehrara

5 Changing Concepts in Lymphatic Pathways 61

Wei-Ren Pan

6 Applied Anatomy 97
Miguel Amore, Lucia Tapia, Gisela Romina Pattarone, Diego Mercado

7 Lymphangiogenesis 113
Jeremy S. Torrisi, Ira L. Savetsky, Jason C. Gardenier, Babak J. Mehrara

8 Impact of Genetics on Lymphangiogenesis 121

Kristiana Gordon, Pia Ostergaard

9 Relationship Between Fat Tissue and Lymphangiogenesis 135

Mauro Andrade

10 Lymphatic Malformations 143

Sandro Michelini, Alessandro Fiorentino, Marco Cardone

11 Immune Regulation by the Peripheral Lymphatics 163

David G. Hancock

xvii

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 17 5/29/2015 9:24:26 AM

 xviii Contents

Part III Pathophysiology and Clinical Presentation

12 Pathophysiology of Primary Lymphedema 177
Byung-Boong Lee, James Laredo

13 Pathophysiology of Secondary Lymphedema 189

Etelka Földi

14 Dermatologic Implications of Secondary Lymphedema of the Lower Leg 195

Terence Ryan, S.R. Narahari, B. Vijaya, Madhur Guruprasad Aggithaya

15 Filaria 215
Gurusamy Manokaran, Rajiv Agarwal, Devisha Agarwal

16 Lymphedema in Pediatric Patients 235

Cristobal Miguel Papendieck

17 Combined Lymphatic and Venous Failure: Phlebolymphedema 247

Audra A. Duncan

18 Lymphedema Risk Factors in Breast Cancer 255

Swetha Kambhampati, Stanley Rockson

19 Sentinel Lymph Node Biopsy Outcomes 263

Janice N. Cormier, Kate D. Cromwell, Jane M. Armer, Merrick I. Ross

Part IV Diagnosis of Lymphedema

20 Causes and Classification of Lymphatic Disorders 277
Swetha Kambhampati, Stanley Rockson

21 Basic Approaches to the Diagnosis of Lymphedema: Clinicians’ Perspective 291

Yener Demirtas, Baris Yigit

22 Biomarkers 299
Kerstin Buttler, Jörg Wilting

23 Clinical Staging of Lymphedema 309

Sandro Michelini, Marco Cardone, Alessandro Fiorentino

24 Measuring Methods 315

Peter C. Neligan

25 Hydromechanics of Intercellular Fluid and Lymph 327

Waldemar Olszewski, Marzanna T. Zaleska

26 Radionuclide Lymphoscintigraphy 349

Byung-Boong Lee, James Laredo

K23349_00_Neligan_FM_m6_cl_i-xxii.indd 18 5/29/2015 9:24:26 AM