Nicoli, F., Constantinides, J., Ciudad, P., Sapountzis, S., Kiranantawat, K., Lazzeri, D., . . . Chen, H.C. (2015). Free lymph node flap transfer and laser-assisted liposuction: A combined technique for the treatment of moderate upper limb lymphedema. Lasers in Medical Science, 30, 1377–1385.

To determine the effectiveness of laser liposuction in combination with a lymph node flap transfer on moderate upper limb lymphedema in patients with breast cancer

Patients first received a lymph node flap transfer. The lymph node flap was placed in the wrist. Laser liposuction was scheduled one to three months following the flap procedure to debulk the affected limb. Measurements were taken preoperatively and at three and six months following the procedure.

• N = 10
• MEAN AGE = 54.6 years (SD = 9.3 years, range = 35–67 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer-related upper limb lymphedema (moderate)
• OTHER KEY SAMPLE CHARACTERISTICS: Breast cancer survivors who received modified radical mastectomies, axillary lymphadenectomy, and chemoradiotherapy

• SITE: Single site    
• SETTING TYPE: Multiple settings    
• LOCATION: Plastic and Reconstructive Surgery Department of the China Medical University Hospital in Taichung, Taiwan

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Palliative care 

Prospective clinical study with pre- and post-test measures

• Photography
• Serial arm measurements 
• DermaLab^® Combo device (skin tonicity) 

Six months after treatment, patients showed a reduction in arm circumference (mean = 30.5 cm, SD = 1.6 cm), which was a 90% improvement from baseline measurements. In addition, forearm circumference was reduced (mean = 27.5 cm, SD = 2.4 cm). This was a 93% improvement from baseline measurements. There was a significant reduction in arm volume from pre- to post-treatment (p > 0.01).

Combining laser liposuction with lymph node flap transfer is a novel procedure. In this study, the intervention appeared safe and reliable, and it was an effective way to significantly reduce limb volume in patients with breast cancer experiencing upper limb lymphedema.

• Small sample (< 30)
• Baseline sample/group differences of import
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)
• Risk of bias (sample characteristics)
• Measurement/methods not well described
• Findings not generalizable
• Intervention expensive, impractical, or training needs

Free lymph node flap transfer and laser-assisted liposuction is very new for lymphedema treatment. This study's results were confusing, and nurses should continue observing this method. The small sample size makes it difficult to determine the extent to which this intervention would be effective for the majority of patients with upper limb lymphedema.