Rationale: To evaluate which factors are associated with change in lymphedema-specific quality of life (QoL) and relative volume difference in the maintenance phase after a multidisciplinary intensive treatment program in patients with lower limb lymphedema(LLL). Methods and Results: In this retrospective study, patients received a multidisciplinary intensive treatment followed by a maintenance phase. In this maintenance phase, patients were advised to perform skin care and exercises and to wear compression garments. Circumferential measurements and the Lymph-ICF-LL questionnaires to determine volume and the lymphedema-specific QoL, respectively, were collected at the start and end of the intensive treatment and at 6 months follow-up. Patient-, lymphedema-, and treatment-related variables were collected to investigate their association with change in lymphedema-specific QoL and relative volume in the maintenance phase. Mann–Whitney U and Spearman rank correlation tests were applied. Patients ( n = 279) who did not receive physiotherapy between 5 and 6 months follow-up and had a lower %score on the 6-minute walk test at the start of the intensive treatment showed significant better improvement in physical function and general tasks/household in the maintenance phase, respectively. Younger age, concomitant lipedema, and a lower % volume reduction during intensive treatment were significantly associated with less relative volume increase in the maintenance phase. Conclusions: Patients without physiotherapy around 5–6 months follow-up or with limited physical capacity at the start may perceive better improvements in certain lymphedema-specific QoL domains, while younger age, concomitant lipedema, and less initial volume reduction appear to be less predisposed to volume regain during the maintenance phase.
Lymphedema remains a significant clinical and research challenge, requiring reliable experimental models to investigate its underlying mechanisms and evaluate potential therapies. Among available options, the surgical mouse tail model is widely used due to its simplicity, reproducibility, and low cost. While prior reviews have examined surgical lymphedema models across species, this is the first systematic review dedicated exclusively to the mouse tail model, providing a comprehensive evaluation of its application in practice and a formal assessment of its methodological reporting quality. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching four databases (PubMed, Embase, Web of Science, and Scopus) from inception to January 2025. Studies claiming to surgically induce lymphedema in the mouse tail were included. We defined lymphedema as a significant volume difference. Reporting quality was assessed using the Animals in Research Reporting In Vivo Experiments (ARRIVE 2.0) guidelines. The review was conducted and reported in accordance with the Synthesis Without Meta-analysis and Statistical Analyses and Methods in the Published Literature guidelines. One hundred five studies were included; 65% (68/105) successfully induced lymphedema. Four main models were identified. The median follow-up period was 35 days, and the median peak of swelling was 14 days. Adverse events such as tail ischemia were reported in 15 studies. Notably, 51% of studies (54/105) lacked controls. The mean reporting quality coefficient was 0.61, corresponding to "average" quality. The surgical mouse tail model is valuable for studying lymphatic pathophysiology but limited by inconsistent methods and reporting. Drawing on 105 studies and a formal multiframework quality assessment, this review identifies six key areas for improvement: (1) standardized induction protocols, (2) validated and consistently reported outcome measures, (3) control-group design, (4) defined minimum follow-up durations, (5) transparent adverse event reporting, and (6) mandatory adherence to ARRIVE 2.0 guidelines.
BACKGROUND Manual lymph drainage (MLD) is commonly used to alleviate upper limb lymphedema; however, objective evidence regarding its physiological efficacy remains limited. METHODS This study aimed to visualize postoperative changes in lymphatic flow and to identify potential collateral drainage pathways following axillary lymph node (LN) dissection using real-time fluorescent lymphography in a rat model. Twelve Wistar rats underwent surgical excision of the right axillary LNs with careful ligation of lymphatic vessels. Indocyanine green (ICG) lymphography was performed at multiple time points from day 3 to week 24 postoperatively using a photodynamic eye (PDE) imaging system. RESULTS Prior to surgery, linear lymphatic signals were observed in the forelimbs. Following the surgery, these signals disappeared and were replaced by diffuse dermal backflow patterns. Over time, network-like signals developed in the axilla and progressed into linear patterns, extending toward the ipsilateral cervical region. In six of the 12 rats, the signals also reached the contralateral axillary fossa via the transverse thoracic pathways. Dermal backflow signs persisted throughout the study period despite the emergence of collateral flow. CONCLUSION These findings suggest that a collateral pathway to the ipsilateral cervical region may support interstitial fluid drainage in the absence of axillary lymphatic vessels. This study provides foundational insights into lymphatic rerouting mechanisms and may contribute to the future evaluation of MLD efficacy using functional imaging.
Background: Chronic lower limb edema (CLLE) is a feature of advanced multiple sclerosis (MS) but its prevalence and causative factors are not clearly established. The aims of the study were to determine the prevalence and possible causative factors of CLLE in people with MS, and to examine the impact of CLLE on participants’ quality of life. Methods and Results: The prevalence of CLLE was determined by questionnaire (i.e., self-reported) and by clinical examination. Possible causative factors were recorded including level of disability using Expanded Disability Status Scale (EDSS) and the impact on participants’ quality of life was assessed using LYMQOL. The self-reported prevalence of CLLE was 42.4% (101/238). The prevalence determined by clinical assessment was 61.9% (99/160). Possible causative factors were shown to include age, reduced mobility, and vasomotor autonomic dysfunction. In the multivariate analysis, only EDSS was statistically significant ( p = 0.002) with an incidence rate ratio (sd) of 2.1 (0.52). In those with CLLE, scores in the function, appearance, and symptom domains of LYMQOL demonstrated a poorer quality of life. There was a higher incidence of cellulitis in those with CLLE (14% compared with 2%). Conclusions: CLLE is a common problem is people with MS but may not always be recognized by patients. It can impact a person’s quality of life and poses a risk of cellulitis. Improved recognition and treatment of CLLE should improve the quality of life of people with MS.
Purpose: The primary aim of this retrospective cohort study was to explore the incidence and independent risk factors of chylous leak after laparoscopic surgery for gynecological malignancies. The secondary aims included quantifying the adverse clinical impacts of chylous leakage on postoperative recovery indicators, summarizing standardized conservative treatment regimens and curative effects of chylous leak patients, and providing intraoperative preventive suggestions for clinical practice. Methods: Data on 495 patients who underwent surgery for gynecologic malignancies in the Department of Gynecology, the Second Hospital of Shandong University from January 2018 to April 2022 were collected. The risk factors related to the occurrence of chylous leak were then analyzed statistically. Results: A total of 394 patients underwent laparoscopic surgery and were divided into 2 groups according to the occurrence of chylous leak after surgery: 19 patients were in the case group, and 375 patients were in the control group. The incidence of chylous leak in this study was 4.82%. Univariate analysis showed preoperative anemia ( p < 0.05, p = 0.01) and enlarged lymph nodes ( p < 0.05, p = 0.008) as risk factors for chylous leak. Statistical analysis of postoperative factors between the two groups showed significantly increased length of hospitalization ( p < 0.05, p ＝ 0.001) and hospitalization costs ( p < 0.05, p = 0.003), postoperative maximum temperature ( p < 0.001) maximum drain output ( p < 0.001), and drainage tube days ( p < 0.001) in the case group compared with the control group. Multivariate binary logistic regression analysis showed that preoperative anemia (OR = 3.111, 95% CI = 1.081–8.953) was the risk factor for chylous leak. Conclusions: The occurrence of chylous leak after laparoscopic surgery for gynecological malignancies leads to prolonged hospital stay, increased medical costs. The possibility of chylous leak occurring after laparoscopic surgery for gynecological malignancies with preoperative anemia is high.
