The investigation of the effects of fenestral tubes with inguinoperitoneal lumen and lumenless capillary rods on lymphedema drainage on A rat hindlimb lymphedema model

Lymphatic system is located into many of our organs and tissues. Its organization consists of a wide network of lymph nodes and lymphatic vessels. The system functions as a filter as a part of the immune system and redirects the interstitial fluid to the circulation. Lymphedema is a result of lymphatic system dysfunction due to insufficient lymphatic transport of interstitial fluid back to the circulation. The accumulation of protein rich interstitial fluid in the intercellular space causes distention, inflammation, proliferation of fatty and connective tissue and finally fibrosis. Lymphedema usually presents as swelling in extremities and causes disfunction. There are also circumstances that head, neck and genital organs getting affected. Lymphedema can be a result of malformations in lymphatic system, problems in development or can be acquired. Complete decongestive therapy is the first line and golden standard treatment for lymphedema and contains manual lymphatic drainage, compression therapy, exercise, skin care and compression garments. If enough response is not seen, surgical approaches can be applied. The indications of surgical therapy are dysfunction of extremity and decreased movement, recurrent episodes of cellulitis and lymphangitis, pain, lymphangiosarcoma and aesthetic considerations. Surgical approach is used for %5-10 of all lymphedema patients. Surgical procedures consist two types of approach: excisional and physiologic procedures. In excisional procedures all lymphedematous epifacial tissue is excised. In physiologic procedures lympho-lymphatic, lympho-venous, lympho-veno-lymphatic or lymph node-venous microsurgical anastomosis are formed. Drainage based treatments in order to reduce lymphedema is first described in early 1900s. Drainage is tried to be accomplished by placing silk sutured through extremity. After the failure of this treatment, drainage-based therapies are abandoned for a long time and focused on microsurgical treatments. In this study we tried to prevent lymphedema through drainage systems applied before the formation of lymphedema at the time of lymphatic dissection. We also apply the drainage systems after formation of lymphedema and try to decrease lymphedema with drainage. We studied on 35 female Sprague-Dawley rats divided into five groups of seven. All left hind limbs of animals went through inguinal and popliteal lymph node dissection and radiotherapy in order to form lymphedema. Contralateral extremities are spared as internal control. Sham group's left hind limbs are only treated with lymph node dissection and radiotherapy. Early fenestrated tube and early silicone rode group have their drainage systems placed at the time of lymph node dissection. Late groups drainage systems are placed after the formation of lymphedema at the 8th week. The weight and extremities are measured weekly. In the beginning of the study, at the 8th week and at 12th week computed tomography is applied in order to measure the volume of the extremities. Through the statistical analysis of the leg circumference and paw thickness measurements, the method is used for forming lymphedema shown successful. Also, early and late drainage systems shown to be successful in preventing and decreasing lymphedema. Volumetric analysis made through computed tomography also correlated with the results.