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鄭明輝教授發表66篇淋巴水腫論文和兩本教科書篇章，與國際學術醫界連結，為顯微重建整型外科及淋巴水腫世界權威 Publications Dr. Cheng's Publications in Lymphedema Microsurgery Dr. Cheng's Book and Chapter 1. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. 淋巴結移植是一種被廣泛應用於治療淋巴水腫的有效方法。傳統上，臨床多將淋巴結移植至腋下，以改善乳癌術後上肢淋巴水腫的症狀。然而，臺灣的鄭明輝教授首創性地提出將鼠蹊部淋巴結移植至手腕遠端的位置，藉此改善淋巴回流，突破過去「近端移植」的慣例。這項技術在臨床上展現出卓越成效，根據平均56個月的長期追蹤，接受手腕移植的患者其患側手臂臂圍平均縮小達50%。這項開創性的研究於2009年發表，並成為首篇證實遠端淋巴結移植具臨床療效的論文，截至目前已被 Google Scholar 引用超過439次，對淋巴結移植術的發展產生深遠影響。 Plast Reconstr Surg. 2009 Apr;123(4):1265-75. doi: 10.1097/PRS.0b013e31819e6529. https://www.ncbi.nlm.nih.gov/pubmed/19337095 2. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Cheng MH, Huang JJ, Nguyen DH, Saint-Cyr M, Zenn MR, Tan BK, Lee CL. 鄭明輝教授第二篇關於淋巴水腫治療的研究展現了極具創新性的突破。他首度提出將下頷骨淋巴結移植至腳踝，用以治療下肢淋巴水腫。過去，針對下肢淋巴水腫的處理方式多限於穿著壓力襪或進行淋巴靜脈吻合術（LVA），然而對於病情較嚴重的患者，這些方法常常效果有限。鄭教授所發展的下頷骨淋巴結移植術，在臨床上展現出顯著的成效，為傳統療法無效的患者帶來了新的希望。此篇論文自發表以來，已被 Google Scholar 引用高達 330 次，顯示其在學術界與臨床實務上的深遠影響。 Gynecol Oncol. 2012 Jul;126(1):93-8. doi: 10.1016/j.ygyno.2012.04.017. Epub 2012 Apr 17. https://www.ncbi.nlm.nih.gov/pubmed/22516659 3. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. 淋巴結移植的可靠性與治療效果如何？近心端或遠心端哪種移植效果更佳？ 在2013年，鄭教授進一步發表研究，採用顯微外科技術進行鼠蹊部淋巴結移植，以治療上肢淋巴水腫。該研究對鼠蹊部淋巴結的解剖構造、受體區域的選擇，以及整體預後表現，皆有詳盡而正面的報告。手術平均可移植超過六顆鼠蹊部淋巴結，並在平均39個月的追蹤期後，患者的臂圍減少達40%，顯示出穩定而良好的治療成效。這項研究為將淋巴結移植至遠端以治療乳癌術後淋巴水腫奠定了成功的基礎。該論文至今已在 Google Scholar 上被引用達351次，顯示其在領域內的重要影響力。 4. Preplanning Vascularized Lymph Node Transfer with Duplex Ultrasonography: An Evaluation of 3 Donor Sites. Patel KM, Chu SY, Huang JJ, Wu CW, Lin CY, Cheng MH. 這篇由 Patel 博士與鄭明輝教授等人於 2014 年發表的研究，針對接受淋巴結移植手術的 68 位淋巴水腫病人，利用超音波（duplex ultrasonography）比較三個常見的淋巴結供應區：下頷骨區（submental）、鼠蹊部（groin）與上鎖骨區（supraclavicular）的解剖結構與血管特徵，協助術前規劃。 在淋巴結數量方面，下頷骨與鼠蹊部平均皆有超過 3 顆淋巴結（分別為 3.1 顆與 3.3 顆），而上鎖骨區僅約 0.9 顆，顯著較少。淋巴結數量越多，移植後的功能恢復潛力越高。 在靜脈直徑的比較中，鼠蹊部的靜脈直徑最大，平均約 12.2 mm，但因其位置較深，術中操作相對困難；下頷骨的靜脈平均約 2.9 mm，雖不及鼠蹊部粗大，但解剖結構清晰、吻合穩定；上鎖骨的靜脈則難以穩定觀察，臨床可行性較低。 皮瓣的厚度與體積亦有差異。鼠蹊部皮瓣最厚、體積最大，次為下頷骨，上鎖骨區則最薄且面積小，限制了其淋巴清除的潛力。厚皮瓣可能導致術後接受區形狀不自然，但也可能與更高的淋巴結密度有關。 綜合以上因素，研究建議首選下頷骨作為血管化淋巴結的供應區，其具備適中的皮瓣體積、穩定的靜脈口徑與高淋巴結數量；若不適合使用下頷骨，則可考慮鼠蹊部，惟需留意可能引發下肢淋巴水腫的風險。上鎖骨雖因疤痕隱蔽而具一定美觀優勢，但因結構與功能限制，不建議作為常規選擇。 這篇研究強調術前影像檢查的重要性，透過超音波能夠精準量測並預估每個病患的最佳淋巴結供應來源，提升淋巴結移植的安全性與成功率。 Plast Reconstr Surg Glob Open. 2014 Sep 8;2(8):e193. doi: 10.1097/GOX.0000000000000105. eCollection 2014 Aug. https://www.ncbi.nlm.nih.gov/pubmed/25426376 5. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study. Dayan JH, Dayan E, Kagen A, Cheng MH, Sultan M, Samson W, Smith ML. J Reconstr Microsurg. 2014 Jan;30(1):41-5. doi: 10.1055/s-0033-1351668. Epub 2013 Sep 9. https://www.ncbi.nlm.nih.gov/pubmed/24019175 6. The mechanism of vascularized lymph node transfer for lymphedema: natural lymphaticovenous drainage. Cheng MH, Huang JJ, Wu CW, Yang CY, Lin CY, Henry SL, Kolios L. 鄭明輝教授2014年發表的重要研究：揭示淋巴結移植有效機制 鄭明輝教授於2014年在《Plastic and Reconstructive Surgery》期刊發表的研究，是刊登於整形外科領域最具權威的國際期刊之一。過去已有三篇研究證實淋巴結移植對淋巴水腫具有良好治療成效，而此篇論文更進一步深入探討「為什麼」淋巴結移植能夠有效改善淋巴水腫，並透過動物實驗與臨床手術觀察，提出科學性的解釋與證據。 在動物實驗部分，研究團隊將循血綠（ICG）注射於淋巴結皮瓣的遠端，可觀察到螢光訊號逐漸移動至連接的靜脈；若直接注射於淋巴結本體，僅需20多秒即在靜脈中出現螢光，顯示移植的淋巴結確實與靜脈系統連通，具備淋巴引流功能。 在臨床方面，當患者接受含有淋巴結的皮瓣移植時，研究顯示循血綠注射至淋巴結後，約在23秒內即可在靜脈中觀察到螢光訊號，進一步證實淋巴結具有快速將淋巴液引流至靜脈的能力。相較之下，若移植僅為皮膚組織，無淋巴結結構，則即使等待一小時，靜脈中仍無螢光顯現，進一步證明淋巴結在整個引流機制中扮演關鍵角色。 這篇具開創性的論文至今已被 Google Scholar 引用達249次，展現其在國際學術界的重要影響力，也為未來發展淋巴結移植治療提供了堅實的理論基礎與臨床依據。 Plast Reconstr Surg. 2014 Feb;133(2):192e-8e. doi: 10.1097/01.prs.0000437257.78327.5b. https://www.ncbi.nlm.nih.gov/pubmed/24469190 7. Developing a Lower Limb Lymphedema Animal Model with Combined Lymphadenectomy and Low-dose Radiation. Yang CY, Nguyen DH, Wu CW, Fang YH, Chao KT, Patel KM, Cheng MH. 過去針對淋巴水腫的研究相對有限。若要進一步發展有效的治療策略，首要之務是深入了解淋巴系統的解剖結構與生理機轉，同時掌握淋巴水腫的發病機制。具備這些知識基礎，才能建立可靠的實驗模型並推動治療方法的驗證與發展。 為此，鄭明輝教授團隊於 2014 年發表了建立小鼠下肢淋巴水腫模型的研究成果，該模型結合雙部位淋巴結切除（鼠蹊與膕窩）與低劑量放射線照射（20 Gy），成功誘發穩定且可量測的慢性下肢淋巴水腫。此模型的特點包括高再現性、低死亡率與顯著的腫脹反應，並透過 Tc-99 淋巴攝影與 micro-CT 體積量測等方式，完整呈現淋巴功能受損後的生理與解剖變化。此研究為後續評估淋巴水腫治療方式的動物實驗提供了重要平台，也為相關臨床研究奠定了基礎。 https://www.ncbi.nlm.nih.gov/pubmed/25289315 8. Vascularized lymph node flap transfer and lymphovenous anastomosis for klippel-trenaunay syndrome with congenital lymphedema. Qiu SS, Chen HY, Cheng MH. 本篇論文報導了一例罕見的先天性淋巴水腫合併 Klippel-Trenaunay Syndrome（KTS）之臨床案例。該患者表現出雙側下肢淋巴水腫及淺層靜脈血管瘤，為臨床上高度複雜且具挑戰性的病症類型。 鄭明輝教授研究團隊根據患者左右下肢病情的嚴重程度差異，採取個別化的手術策略：在症狀較輕的右側施行淋巴靜脈吻合術（Lymphovenous Anastomosis, LVA），而在病變較嚴重的左側則進行血管化淋巴結移植（Vascularized Lymph Node Transfer, VLNT）。術後結果顯著，患者雙側水腫均明顯改善，復發率低，感染次數明顯下降，整體生活品質獲得提升，展現出兩種手術技術在臨床應用上的互補性與實用性。 此案例凸顯出，先天性淋巴水腫常伴隨其他血管或器官發育異常，使得診斷與治療更加複雜。因此，治療前的精確臨床評估與完整影像學分析至關重要。對於病情複雜者，應依據病灶位置、嚴重度與組織狀態，選擇最適當的手術方式，而非僅依賴單一技術。 本研究除了提供治療複雜型先天性淋巴水腫的寶貴經驗，也體現了鄭明輝教授在臨床與影像整合診斷領域的深耕與貢獻。透過個別化手術策略的設計與應用，為具多重併發症的淋巴水腫患者，開創出更有效、精準的治療選擇。 Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e167. doi: 10.1097/GOX.0000000000000099. eCollection 2014 Jun. https://www.ncbi.nlm.nih.gov/pubmed/25289360 9. From theory to evidence: long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers. Patel KM, Lin CY, Cheng MH. 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 10. Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats. Nguyen DH, Chou PY, Hsieh YH, Momeni A, Fang YH, Patel KM, Yang CY, Cheng MH. Microsurgery. 2016 Mar;36(3):239-45. doi: 10.1002/micr.22388. Epub 2015 Feb 25. https://www.ncbi.nlm.nih.gov/pubmed/25715830 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 11. Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure. Ito R, Lin MC, Cheng MH. 這篇於 2015 年發表的臨床報告，記錄一位 59 歲女性在接受子宮內膜癌治療後，出現左下肢長期淋巴水腫，曾接受 Charles Procedure（將整個小腿的皮下組織與皮膚切除再補皮）後仍反覆感染並惡化。鄭明輝教授團隊為她設計了創新的治療方式，同時移植兩側下頷骨的血管化淋巴結皮瓣：一側移植到腳踝處改善腳部感染與蜂窩性組織炎，另一側移植到大腿靠近膝蓋的位置以改善大腿淋巴回流。手術後，病人感染停止、腿圍明顯縮小，且不再需要穿壓力襪，整體生活品質大幅提升。此案例證明，在 Charles Procedure 術後仍惡化的淋巴水腫病人身上，雙側下頷骨淋巴結移植可成為一個有效的治療方案。 Plast Reconstr Surg Glob Open. 2015 Sep 15;3(9):e513. doi: 10.1097/GOX.0000000000000489. eCollection 2015 Sep. https://www.ncbi.nlm.nih.gov/pubmed/26495226 12. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Ito R, Wu CT, Lin MC, Cheng MH. Microsurgery. 2016 May;36(4):310-5. doi: 10.1002/micr.30010. Epub 2015 Dec 15. https://www.ncbi.nlm.nih.gov/pubmed/26666982 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 13. Lymphedema surgery: Patient selection and an overview of surgical techniques. Allen RJ Jr, Cheng MH. 這篇由 Robert Allen Jr. 與鄭明輝教授團隊於 Journal of Surgical Oncology 發表的論文，系統性地回顧了各種淋巴水腫手術方式，並強調「病人選擇」的重要性。文章指出，淋巴水腫並非單一手術即可全面解決，而是需依照疾病分期與病程嚴重度來選擇適合的治療。根據鄭式淋巴水腫分期，第0期的患者多屬於可逆階段，適合以復健與保守治療為主；第1期與早期第2期仍保有部分淋巴通路，最適合進行淋巴靜脈吻合術（LVA）；晚期第2期到第4期患者因淋巴管已大幅阻塞或纖維化，則較適合血管化淋巴結移植（VLNT）等重建手術。透過這樣的治療分流，可以讓醫師與病人進行更清楚的溝通，避免不當手術導致效果不佳，也提高預後的成功率。此篇論文自發表以來已被引用超過 159 次，不僅整理了當時主要的手術策略，也為臨床醫師在選擇手術方式時提供了實用的指引。 J Surg Oncol. 2016 Jun;113(8):923-31. doi: 10.1002/jso.24170. Epub 2016 Feb 5. Review. https://www.ncbi.nlm.nih.gov/pubmed/26846615 14. Surgical anatomy of the vascularized submental lymph node flap: Anatomic study of correlation of submental artery perforators and quantity of submental lymph node. Tzou CH, Meng S, Ines T, Reissig L, Pichler U, Steinbacher J, Pona I, Roka-Palkovits J, Rath T, Weninger WJ, Cheng MH. J Surg Oncol. 2017 Jan;115(1):54-59. doi: 10.1002/jso.24336. Epub 2016 Jun 23. https://www.ncbi.nlm.nih.gov/pubmed/27338566 淋巴結移植已被證實是治療淋巴水腫的有效方法，並在臨床上累積了許多成功案例。鄭教授發展並深入研究下頷淋巴結移植的外科解剖，包括其解剖位置、血管穿通支的分布與淋巴結的數量，並已於學術期刊發表。本篇論文為鄭教授與奧地利維也納周教授共同完成；周教授當時為鄭教授的學生，現已成為奧地利淋巴水腫領域的重要專家。 研究結果顯示，下頷骨區域平均可找到約三顆體積較大的淋巴結，並伴隨約四條穩定的血管穿通支，提供良好的血流灌注，使該區皮瓣在移植至遠端時仍具可靠的血液供應。此外，研究指出神經構造相對穩定，其路徑多位於臉動脈的表層，因此在手術剝離過程中能夠清楚辨識並加以保護，降低神經損傷的風險。 綜合而言，下頷部至少具備三顆可用的淋巴結與良好的血管供應，且神經走行明確、易於保護。這些特徵使下頷淋巴結皮瓣成為臨床上進行血管化淋巴結移植（VLNT）時，一個安全、穩定且極具臨床價值的供區。 15. The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform. Loh CY, Wu JC, Nguyen A, Dayan J, Smith M, Masia J, Chang D, Koshima I, Cheng MH. 第五屆世界淋巴水腫手術研討會於 2016 年在台灣長庚醫院舉行，由鄭明輝教授與來自巴塞隆納的 Jaume Masia、芝加哥的 David Chang 等國際專家共同推動，旨在建立一個全球知識交流平台，整合臨床經驗、基礎研究與技術發展。研討會安排多場現場手術，包括淋巴靜脈吻合（LVA）、血管化淋巴結移植（VLNT）、以及不同供應區如頷下、鎖骨上、腹網膜等淋巴結皮瓣的應用，並透過即時轉播與專家評論，促進與會醫師之間的互動與學習。這次會議獲得 Journal of Surgical Oncology 主編的支持，會中高品質論文也收錄於該期刊發表，使研討會不僅成為外科醫師臨床與研究交流的重要平臺，更為年輕醫師提供了實際觀摩與參與的機會，推動淋巴水腫手術在全球整形重建外科領域快速成長與發展。 16. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer. Steinbacher J, Tinhofer IE, Meng S, Reissig LF, Placheta E, Roka-Palkovits J, Rath T, Cheng MH, Weninger WJ, Tzou CH. J Surg Oncol. 2017 Jan;115(1):60-62. doi: 10.1002/jso.24346. Epub 2016 Jun 28. https://www.ncbi.nlm.nih.gov/pubmed/27353521 17. The 5th World Symposium for Lymphedema Surgery. Cheng MH, Koshima I, Chang DW, Masia J. J Surg Oncol. 2017 Jan;115(1):5. doi: 10.1002/jso.24383. Epub 2016 Jul 29. No abstract available. https://www.ncbi.nlm.nih.gov/pubmed/27473624 18. Platysma-sparing vascularized submental lymph node flap transfer for extremity lymphedema. Poccia I, Lin CY, Cheng MH. J Surg Oncol. 2017 Jan;115(1):48-53. doi: 10.1002/jso.24350. Epub 2017 Jan 6. https://www.ncbi.nlm.nih.gov/pubmed/28058777 這篇文章介紹了一項改良的 Platysma 保留式下頷骨淋巴結皮瓣移植。傳統手術常需切除 platysma 肌肉，可能造成下唇短暫無力或笑容不對稱。改良技術則在設計上保留內側 platysma，並在顯微鏡下保護邊緣性下頷神經，使病人術後既能獲得淋巴水腫的改善，又能避免口唇運動異常。臨床比較顯示，兩組患者的皮瓣均完全存活，但改良組沒有出現神經假性麻痺，且手術效率更高。此技術兼顧功能與美觀，顯著降低供應區後遺症，為淋巴水腫治療提供更安全的選擇。 Platysma-Sparing Vascularized Submental Lymph Node Flap Transfer for Extremity Lymphedema 19. A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap. Cheng MH, Lin CY, Patel KM. 這篇 2017 年發表於《Journal of Surgical Oncology》的研究，針對 下頷骨血管化淋巴結皮瓣（submental vascularized lymph node flap, VSLN flap） 的解剖變異進行前瞻性臨床評估，目的是幫助外科醫師更安全有效地進行皮瓣的剝離與移植。 研究共分析了 49 例病人，其中 42 例提供完整的解剖資訊。結果顯示，下頷骨動脈與靜脈的走向存在顯著的變異。最常見的情況是動脈與靜脈都行經於下頷下腺的上方，約佔 31%。其次，動脈可能穿過腺體，或靜脈位於腺體下方、旁邊，甚至出現兩條主靜脈並行的情形。這些不同的組合，會直接影響手術剝離的難度與耗時，其中 動脈經過腺體內部時，手術時間會明顯延長。 在每個皮瓣內，平均可找到約 2 個左右的淋巴結，若動脈路徑經腺體內部，往往能取得更多顯著的淋巴結。研究也發現，術前使用超音波檢查有助於精準定位淋巴結與血管走向，降低手術中意外損傷的風險。 這篇研究強調 下頷骨淋巴結皮瓣存在高度的血管解剖變異，熟悉這些變化並在術前善用影像工具，能幫助初學者及臨床醫師在進行淋巴結移植時更加安全、順利。對於治療較嚴重（鄭式分期第 III 至 IV 期）的淋巴水腫患者，這些解剖知識能直接影響手術成果與臨床效果。 J Surg Oncol. 2017 Jan;115(1):43-47. doi: 10.1002/jso.24487. Epub 2017 Jan 13. https://www.ncbi.nlm.nih.gov/pubmed/28083889 20. Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. 上肢淋巴水腫的治療常以腹股溝淋巴結移植或下頷淋巴結移植作為主要選擇，其中下頷淋巴結皮瓣通常能提供更穩定的效果。然而，部分病患因個別臨床條件而受限，例如鼻咽癌病史導致頸部接受過放射線治療，或曾進行過腹股溝淋巴結移植及淋巴靜脈吻合手術但皆未成功。針對這類無法再使用常見供區的病人，腹網膜淋巴結移植可作為替代方案。 本研究報告一位乳癌術後併發上肢淋巴水腫的病人，因無法再利用腹股溝或下頷部淋巴結作為供區，最終採用腹網膜淋巴結移植。手術後病人的上肢腫脹情形顯著改善，體積減少約達 40%，顯示腹網膜淋巴結移植在特殊情況下仍具有良好的臨床效果與可行性。腹網膜淋巴結的優點是有2組動靜脈循環，但缺點是要剖腹傷口、淋巴結較少較小、靜脈回流較不可靠、沒有皮膚附著。 Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. doi: 10.1097/GOX.0000000000001288. eCollection 2017 Apr. https://www.ncbi.nlm.nih.gov/pubmed/28507857 21. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study. Tinhofer IE, Meng S, Steinbacher J, Roka-Palkovits J, Györi E, Reissig LF, Cheng MH, Weninger WJ, Tzou CH. J Surg Oncol. 2017 Dec;116(8):1062-1068. doi: 10.1002/jso.24783. Epub 2017 Aug 7. 這篇文章介紹了一項改良的 Platysma 保留式下頷骨淋巴結皮瓣移植。傳統手術常需切除 platysma 肌肉，可能造成下唇短暫無力或笑容不對稱。改良技術則在設計上保留內側 platysma，並在顯微鏡下保護邊緣性下頷神經，使病人術後既能獲得淋巴水腫的改善，又能避免口唇運動異常。臨床比較顯示，兩組患者的皮瓣均完全存活，但改良組沒有出現神經假性麻痺，且手術效率更高。此技術兼顧功能與美觀，顯著降低供應區後遺症，為淋巴水腫治療提供更安全的選擇。 Platysma-Sparing Vascularized Submental Lymph Node Flap Transfer for Extremity Lymphedema 22. Visualization of Skin Perfusion by Indocyanine Green Fluorescence Angiography-A Feasibility Study. Steinbacher J, Yoshimatsu H, Meng S, Hamscha UM, Chan CS, Weninger WJ, Wu CT, Cheng MH, Tzou CH. Plast Reconstr Surg Glob Open. 2017 Sep 25;5(9):e1455. doi: 10.1097/GOX.0000000000001455. eCollection 2017 Sep. https://www.ncbi.nlm.nih.gov/pubmed/29062637 23. Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes. Pappalardo M, Patel K, Cheng MH. J Surg Oncol. 2018 Jun;117(7):1420-1431. doi: 10.1002/jso.25034. Epub 2018 Mar 24. Review. https://www.ncbi.nlm.nih.gov/pubmed/29572824 24. Vascularized Lymph Node Transfer for Lymphedema. Schaverien MV, Badash I, Patel KM, Selber JC, Cheng MH. Semin Plast Surg. 2018 Feb;32(1):28-35. doi: 10.1055/s-0038-1632401. Epub 2018 Apr 9.Review. https://www.ncbi.nlm.nih.gov/pubmed/29636651 25. Accurate Prediction of Submental Lymph Nodes Using Magnetic Resonance Imaging for Lymphedema Surgery. Asuncion MO, Chu SY, Huang YL, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 Mar 23;6(3):e1691. doi: 10.1097/GOX.0000000000001691. eCollection 2018 Mar. https://www.ncbi.nlm.nih.gov/pubmed/29707451 26. Critical Ischemia Time, Perfusion and Drainage Function of Vascularized Lymph Nodes. Yang CY, HO OA, Cheng MH, Hsiao HY. Plast Reconstr Surg. 2018 Jun 12. doi: 10.1097/PRS.0000000000004673. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/29927833 27. Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema. Gustafsson J, Chu SY, Chan WH, Cheng MH. Plast Reconstr Surg. 2018 Jul 10. doi: 10.1097/PRS.0000000000004793. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30020232 28. Acoustic Radiation Force Impulse Elastography: Tissue Stiffness Measurement in Limb Lymphedema. Chan WH, Huang YL, Lin C, Lin CY, Cheng MH, Chu SY. Radiology. 2018 Aug 14:172869. doi: 10.1148/radiol.2018172869. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30106341 29. Lymph node transplantation for the treatment of lymphedema. Gould DJ, Mehrara BJ, Neligan P, Cheng MH, Patel KM. J Surg Oncol. 2018 Aug 21. doi: 10.1002/jso.25180. [Epub ahead of print] Review. https://www.ncbi.nlm.nih.gov/pubmed/30129675 30. Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using Volumetric and Circumferential Differences Gustafsson J, Chu SY, Chan WH, Cheng MH. Plast Reconstr Surg. 2018 Jul 10. doi: 10.1097/PRS.0000000000004793. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30020232 31. Lymphedema and concomitant venous comorbidity in the extremity: Comprehensive evaluation, management strategy, and outcomes. Sachanandani N S, Chu SY, Ho O A., Cheong CF, Lin CY, Cheng MH*. J Surg Oncol. 2018 Nov;118(6):941-952. doi: 10.1002/jso.25237. https://www.ncbi.nlm.nih.gov/pubmed/ ? term=Lymphedema+and+concomitant+venous+comorbidity+in+the+extremity%3A+Comprehensive+evaluation%2C+management+strategy%2C+and+outcomes 32. Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatmentof Primary Lymphedema. Cheng MH, Loh CYY, Lin CY. Plats Reconstr Surg Glob Open. 2018 Dec 20;6(12):e2056. https://journals.lww.com/prsgo/Fulltext/2018/12000/Outcomes_of_Vascularized_Lymph Node_Transfer_and.15.aspx 33. Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for BreastCancer-Related Lymphedema. Ho OA, Lin CY, Pappalardo M, Cheng MH. Plats Reconstr Surg Glob Open. 2018 Dec 13;6(12):e1923. https://journals.lww.com/prsgo/Fulltext/2018/12000/Comparisons_of_Submental_and_Groin_Vascularized.13.aspx 34. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Sachanandani N S, Chu SY, Ho O A., Cheong CF, Lin CY, Cheng MH*. 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 35. Proposed pathway and mechanism of vascularized lymph node flaps. Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. 這篇 2016 年發表於 Gynecologic Oncology 的研究由鄭明輝教授團隊主導，透過大鼠與人體實驗證實血管化淋巴結皮瓣（VLN）能有效吸收組織間液並將其導入靜脈，揭示了其「抽水幫浦」般的作用機制。實驗顯示，只有含淋巴結的皮瓣在浸泡含有足夠濃度蛋白質（≥3%）的螢光染劑溶液時，才會在靜脈中出現螢光訊號，證明淋巴液與蛋白質先經淋巴毛細管進入淋巴結，再透過高內皮小靜脈轉運至靜脈系統，從而完成引流。臨床上，接受下頷下淋巴結移植的病人皆在一年內獲得症狀改善。此研究首次清楚闡明了淋巴結移植的運作路徑與機制，已成為整形重建外科界廣泛引用的重要依據，並被引用超過 100 次。 Gynecol Oncol. 2016 Apr;141(1):182-8. doi: 10.1016/j.ygyno.2016.01.007. Epub 2016 Jan 7. https://www.ncbi.nlm.nih.gov/pubmed/26773469 36. Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Ho OA, Lin CY, Pappalardo M, Cheng MH. Ann Surg. 2017 Jun 7. doi: 10.1097/SLA.0000000000002322. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28594742 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 37. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Ann Surg. 2018 Sep;268(3):513-525. doi: 10.1097/SLA.0000000000002917. https://www.ncbi.nlm.nih.gov/pubmed/30004927 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 38. Dorsal Wrist Placement for Vascularized Submental Lymph Node Transfer Significantly Improves Breast Cancer-Related Lymphedema. Hattan A, Fries Charles Anton, BChir, FRCS, Cheng Ming-Huei. Plastic and Reconstructive Surgery - Global Open: 2019 Feb, 7(2): e2149. https://journals.lww.com/prsgo/Fulltext/2019/02000/Dorsal_Wrist Placement_for_Vascularized_Submental.14.aspx 這篇由鄭明輝教授與其團隊於《Journal of Reconstructive Microsurgery》發表的論文，針對「遠端血管化淋巴結移植」（distal vascularized lymph node transfer, VLNT）的機轉與臨床整合，進行了具代表性的長期追蹤與實驗性評估。傳統上，淋巴結移植多選擇在近端（如腋下或鼠蹊部）作為接受區，基於再建局部淋巴通道的理論。然而，臨床上發現即使將淋巴結移植至遠端（如手腕、腳踝），仍能有效改善患肢淋巴水腫，卻缺乏對此機制的完整理解。本研究即是為了補足這項知識缺口。 研究團隊從長庚醫院的資料庫中選取了20位接受遠端VLN移植、且追蹤時間超過一年以上的病人，平均追蹤時間為27.3個月。移植位置包含手腕、手肘與腳踝，移植來源則為鼠蹊部或下頷部淋巴結。在術後，團隊利用螢光顯影劑 Indocyanine Green（ICG），在移植區近心端注射，觀察螢光劑是否流入移植的淋巴結。結果顯示，所有病人皆有ICG向遠心端流動並進入移植的淋巴結，顯示移植淋巴結與周邊淋巴系統已產生有效整合。更重要的是，ICG出現的時間（latency period）與患肢圍度改善程度呈現顯著負相關——顯影越快的病人，其淋巴水腫改善越明顯。 研究進一步指出，這種遠端移植的效果之所以顯著，可能與病人原有的近端淋巴管已遭受手術或放射線破壞有關，導致近端再建效果有限。而遠端區域尚保有殘存的淋巴管網與靜脈系統，移植的淋巴結透過內在的「淋巴-靜脈通道」（lymphovenous connections），可直接將淋巴液排入靜脈循環，發揮更直接有效的引流功能。這種流動方向甚至在病人平躺時（即重力中立）亦明確觀察得到，說明其非單純依賴重力，而是反映整體微循環與淋巴靜脈整合的真實生理功能。 最後，研究強調這種遠端非解剖位置的移植不僅可行，且在長期追蹤下效果穩定。作者建議對於晚期、嚴重的淋巴水腫個案，應重新思考傳統近端植入策略，並考慮遠端移植作為更具功能性的治療選項。這篇論文不僅為遠端淋巴結移植提供了明確的機轉證據，也對未來臨床策略的選擇與評估方式提出了嶄新方向。 J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 39. Comparison of Outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema. Fahad K. Al-Jindan, Lin CY, Cheng MH. 這篇 2019 年發表於《Plastic and Reconstructive Surgery》的研究，針對早期肢體淋巴水腫，直接比較了 邊對端 (side-to-end, STE) 與 端對端 (end-to-end, ETE) 淋巴靜脈吻合術的臨床成果。研究共納入 58 位病人，其中 23 位接受 ETE，35 位接受 STE，所有患者皆在術前經螢光綠淋巴攝影確認有功能性的淋巴管。手術均由同一位資深外科醫師於高倍率顯微鏡下完成，平均追蹤時間超過 16 個月。 結果顯示，兩種吻合方式都能有效改善早期淋巴水腫，但 STE 的表現更佳。在肢體圍度減少方面，STE 組平均改善 3.2%，明顯優於 ETE 組的 2.2%。蜂窩性組織炎的發作次數在術後兩組皆大幅下降，從每年平均 1.7 次降至 0.7 次，但 STE 組的改善幅度更為明顯，尤其在上肢與下肢患者中皆有較佳的臨床效果。所有患者在手術後都能恢復日常生活，並且不再依賴壓力衣。 機制方面，研究指出 STE 的優勢在於 保留了淋巴管的連續性。這種吻合方式可以同時引流近端與遠端的淋巴液，維持淋巴管的收縮與功能；相對而言，ETE 需要切斷淋巴管，只能處理遠端的淋巴回流，因此功能上較受限制。 這項研究證實了淋巴靜脈吻合術對早期淋巴水腫確實有效，而邊對端吻合術在臨床效果上更具優勢，特別是在減少肢體腫脹與控制蜂窩性組織炎方面，為日後手術策略的選擇提供了有力的依據。 Plast Reconstr Surg. 2019 May 10. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31188305 40. Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema. Lin CY, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):67-74. doi: 10.1002/jso.25523. Epub 2019 Jun 18. https://www.ncbi.nlm.nih.gov/pubmed/31209885 這篇 2019 年發表於《Plastic and Reconstructive Surgery》的研究，針對早期肢體淋巴水腫，直接比較了 邊對端 (side-to-end, STE) 與 端對端 (end-to-end, ETE) 淋巴靜脈吻合術的臨床成果。研究共納入 58 位病人，其中 23 位接受 ETE，35 位接受 STE，所有患者皆在術前經螢光綠淋巴攝影確認有功能性的淋巴管。手術均由同一位資深外科醫師於高倍率顯微鏡下完成，平均追蹤時間超過 16 個月。 結果顯示，兩種吻合方式都能有效改善早期淋巴水腫，但 STE 的表現更佳。在肢體圍度減少方面，STE 組平均改善 3.2%，明顯優於 ETE 組的 2.2%。蜂窩性組織炎的發作次數在術後兩組皆大幅下降，從每年平均 1.7 次降至 0.7 次，但 STE 組的改善幅度更為明顯，尤其在上肢與下肢患者中皆有較佳的臨床效果。所有患者在手術後都能恢復日常生活，並且不再依賴壓力衣。 機制方面，研究指出 STE 的優勢在於 保留了淋巴管的連續性。這種吻合方式可以同時引流近端與遠端的淋巴液，維持淋巴管的收縮與功能；相對而言，ETE 需要切斷淋巴管，只能處理遠端的淋巴回流，因此功能上較受限制。 這項研究證實了淋巴靜脈吻合術對早期淋巴水腫確實有效，而邊對端吻合術在臨床效果上更具優勢，特別是在減少肢體腫脹與控制蜂窩性組織炎方面，為日後手術策略的選擇提供了有力的依據。 Plast Reconstr Surg. 2019 May 10. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31188305 41. Lymphoscintigraphy for the Diagnosis of Extremity Lymphedema: Current Controversies Regarding Protocol, Interpretation and Clinical Application. Pappalardo M, Cheng MH. J Surg Oncol. 2020 Jan;121(1):37-47. doi: 10.1002/jso.25526. Epub 2019 Jun 18. https://www.ncbi.nlm.nih.gov/pubmed/31209893 這篇 2019 年發表於《Plastic and Reconstructive Surgery》的研究，針對早期肢體淋巴水腫，直接比較了 邊對端 (side-to-end, STE) 與 端對端 (end-to-end, ETE) 淋巴靜脈吻合術的臨床成果。研究共納入 58 位病人，其中 23 位接受 ETE，35 位接受 STE，所有患者皆在術前經螢光綠淋巴攝影確認有功能性的淋巴管。手術均由同一位資深外科醫師於高倍率顯微鏡下完成，平均追蹤時間超過 16 個月。 結果顯示，兩種吻合方式都能有效改善早期淋巴水腫，但 STE 的表現更佳。在肢體圍度減少方面，STE 組平均改善 3.2%，明顯優於 ETE 組的 2.2%。蜂窩性組織炎的發作次數在術後兩組皆大幅下降，從每年平均 1.7 次降至 0.7 次，但 STE 組的改善幅度更為明顯，尤其在上肢與下肢患者中皆有較佳的臨床效果。所有患者在手術後都能恢復日常生活，並且不再依賴壓力衣。 機制方面，研究指出 STE 的優勢在於 保留了淋巴管的連續性。這種吻合方式可以同時引流近端與遠端的淋巴液，維持淋巴管的收縮與功能；相對而言，ETE 需要切斷淋巴管，只能處理遠端的淋巴回流，因此功能上較受限制。 這項研究證實了淋巴靜脈吻合術對早期淋巴水腫確實有效，而邊對端吻合術在臨床效果上更具優勢，特別是在減少肢體腫脹與控制蜂窩性組織炎方面，為日後手術策略的選擇提供了有力的依據。 Plast Reconstr Surg. 2019 May 10. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31188305 42. Intra-abdominal Chylovenous Bypass Treats Retroperitoneal Lymphangiomatosis. Chen C, Cheng MH et al. 這篇發表於《Journal of Surgical Oncology》的研究，探討 後腹膜淋巴管增生症（retroperitoneal lymphangiomatosis, RL） 伴隨淋巴水腫與腹水的治療策略。RL 屬於罕見的先天性淋巴異常，因後腹膜淋巴管異常增生導致乳糜性腹水（chylous ascites），病人常出現下肢淋巴水腫、營養不良、體重上升、免疫力下降，容易反覆感染甚至敗血症。診斷上需結合淋巴攝影、磁振造影（MRI）、單光子電腦斷層（SPECT）等影像學檢查。 研究回顧 2012 至 2018 年間 44 例原發性下肢淋巴水腫患者，其中 6 位被診斷為 RL（盛行率約 13.6%）。這些病人接受了 血管化淋巴結移植（VLNT） 治療下肢淋巴水腫，並針對乳糜性腹水進行 腹腔內邊對端乳糜靜脈繞道手術（chylovenous bypass, CVB）。手術方式是由一般外科進行腹部探查，找到乳糜外漏源頭，再由顯微外科將病灶處的淋巴流引流到卵巢靜脈或內髂靜脈。這項技術的挑戰性極高，需要跨科團隊合作。 臨床結果顯示，所有 6 位病人的 CVB 均保持通暢（其中 1 人需再吻合一次），乳糜性腹水完全解決，病人能恢復正常飲食與活動。手術後，下肢肢圍平均改善 4.2 公分（p=0.043），蜂窩性組織炎發作次數由每年 1.9 次顯著降至 0.1 次（p=0.04），生活品質評分從 3.4 提升到 5.7（p=0.023）。營養狀態（白蛋白）與體重則有輕度改善，但未達顯著差異。大多數病人在半年內可停止穿著壓力衣。 這項研究證實腹腔內邊對端乳糜靜脈繞道結合淋巴結移植，能有效處理 RL 所造成的乳糜性腹水與下肢淋巴水腫，顯著減少感染、改善肢體腫脹並提升生活品質。對於嚴重或先天性淋巴水腫合併腹水的病人，這項手術提供了一條可行且具生理性的治療途徑。J Surg Oncol. 2020 Jan;121(1):75-84. doi: 10.1002/jso.25514. Epub 2019 Jul 4. https://www.ncbi.nlm.nih.gov/pubmed/31273800 43. Lymphedema Microsurgery Reduces the Rate of Implant Removal for Patients Who Have Pre-existing Lymphedema and Total Knee Arthroplasty for Knee Osteoarthritis. Voravitvet TY, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):57-66. doi: 10.1002/jso.25517. Epub 2019 Jun 13. https://www.ncbi.nlm.nih.gov/pubmed/31197837 44. Clinical Features, Microbiological Epidemiology and Recommendations of Management for Cellulitis in Extremity Lymphedema. Rodriguez JR, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):25-36. doi: 10.1002/jso.25525. Epub 2019 Jul 2. https://www.ncbi.nlm.nih.gov/pubmed/31264724 45. Delayed Primary Retention Suture: A new technique to inset Vascularized Submental Lymph Node Transfer. Koide S, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):138-143. doi: 10.1002/jso.25520. Epub 2019 Jul 5. https://www.ncbi.nlm.nih.gov/pubmed/31276208 46. Long-Term Outcome of Lower Extremity Lymphedema Treated with Vascularized Lymph Node Flaps with Venous Complications. Koide S, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):129-137. doi: 10.1002/jso.25602. Epub 2019 Jun 27. https://www.ncbi.nlm.nih.gov/pubmed/31246288 47. Summary of hands-on supermicrosurgery course and live surgeries at 8th world symposium for lymphedema surgery. Pappalardo M, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):8-19. doi: 10.1002/jso.25619. Epub 2019 Jul 16. https://www.ncbi.nlm.nih.gov/pubmed/31309553 48. Introduction of the 8th World Symposium for Lymphedema Surgery. Cheng MH, Chang DW, Masia J, Koshima I. J Surg Oncol. 2020 Jan;121(1):7. doi: 10.1002/jso.25620. Epub 2019 Jul 9. https://www.ncbi.nlm.nih.gov/pubmed/31290156 49. Impacts of Arterial Ischemia or Venous Occ.usion on Vascularized Groin Lymph Nodes in a Rat Model. Tinhofer I. E., Yang CY, Chen C, Cheng MH. J Surg Oncol. 2020 Jan;121(1):153-162. doi: 10.1002/jso.25518. Epub 2019 May 31. https://www.ncbi.nlm.nih.gov/pubmed/31152457 50. Volumetric Differences in the Superficial and Deep Compartments of Patients with Secondary Unilateral Lower Limb Lymphedema. Chu SY, Cheng MH et al. Plast Reconstr Surg. (paper in press) 51. Efficacy validation of a lymphatic drainage device for lymphedema drainage in a rat model. Cheng MH, Yang CY, Tee R, Hong YT, Lu CC. J Surg Oncol. 2019 Dec;120(7):1162-1168. https://www.ncbi.nlm.nih.gov/pubmed/?term=Efficacy+validation+of+a+lymphatic+drainage+device+for+lymphedema+drainage+in+a+rat+model 52. Institutionalization of Reconstructive Lymphedema Surgery in Austria - Single Center Experience. Tzou CHJ, Cheng MH et al. J Surg Oncol. 2020 Jan; 121(1):91-99. https://www.ncbi.nlm.nih.gov/pubmed/?term=Institutionalization+of+Reconstructive+Lymphedema+Surgery+in+Austria+%E2%80%93+Single+Center+Experience 53. Comparisons of Manual Tape Measurement and Morphomics Measurement of Patients with Upper Extremity Lymphedema. Horbal SR, Chu SY, Cheng MH* et al. Plast Reconstr Surg Global Open. 2019 Oct 29;7(10): e2431 https://www.ncbi.nlm.nih.gov/pubmed/ ? 54. Characterization of limb lymphedema using the statistical analysis of ultrasound backscattering. Lee YL, Cheng MH et al. Quant Imaging Med Surg. 2020;10(1):48-56. 55. Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*, Tee R, Chen C, Lin CY, Pappalardo M. Ann Surg Oncol. 2020 Jun 18. doi: 10.1245 56. ASO Author Reflection: Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Horbal SR, Chu SY, Cheng MH* et al. Ann Surg Oncol. 2020 Jul 10. 57. Lymphedema microsurgery improved outcomes of pediatric primary extremity lymphedema. Cheng MH*, Liu TTF. Microsurgery, 2020 Jul 11. 58. Chylovenous bypass for mesenteric lymphangiomatosis: A case report. Chen C,Cheng MH*. J Surg Oncol. 2020 Jul 15. 59. Staging and clinical correlations of lymphoscintigraphy for unilateral gynecological cancerrelated lymphedema. Pappalardo M, Lin C, Ho OA, Kuo CF, Lin CY, Cheng MH". J Surg Oncol. 2020 Mar;121(3):422-434. 60. Morbidity of Marginal Mandibular Nerve Post Vascularized Submental Lymph Node Flap Transplantation. Chang Tommy NJ, Lee CH, Lin Jennifer AJ, Cheng MH*. J Surg Oncol. 2020 Dec;122(8):1747-1754 https://pubmed.ncbi.nlm.nih.gov/32869304/ 61. Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*, Tee R, Chen C, Lin CY, Pappalardo M. Ann Surg Oncol. 2020 Jun 18. https://pubmed.ncbi.nlm.nih.gov/32556869/ 62. ASO Author Reflections: Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*. Ann Surg Oncol. 2020 Dec;27(13):5277-5278. https://pubmed.ncbi.nlm.nih.gov/32651692/ 63. Response to letter to the editor: Evidence of Lymph Flow Amelioration on Indocyanine Green Lymphography after Vascularized Lymph Node Transfer. Cheng MH". Ann Surg Oncol. 2021 Jun;123(7):1641. https://pubmed.ncbi.nlm.nih.gov/33825195/ 64. Retrograde Manual Lymphatic Drainage following Vascularized Lymph Node Transfer to Distal Recipient Sites for Extremity Lymphedema: A Retrospective Study and Literature Review. Roka-Palkovits J, Lin CY, Tzou CH J, Tinhofer, Cheng MH*. Plast Reconstr Surg. 2021 Sep 1;148(3):425e-436e. https://pubmed.ncbi.nlm.nih.gov/34432699/ 65. Immediate Lymphovenous Bypass Treated Donor Site Lymphedema during Phalloplasty for Gender Dysphoria. Lin W, Safa B, Chen M, Cheng MH*. Plast Reconstr Surg Glob Open. 2021 Sep 17;9(9):e3822. https://pubmed.ncbi.nlm.nih.gov/34549009/ 66. Heparin-induced thrombocytopenia and thrombosis in primary lymphedema patients who underwent vascularized lymph node transplantations. Hsu SY, Lin CY, Cheng MH*. J Surg Oncol. 2022 Feb 2. https://pubmed.ncbi.nlm.nih.gov/35107827 Book: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015. Principles and Practice of Lymphedema Surgery 2nd Edition - January 7, 2021 Ming-Huei Cheng, David Chang, Ketan Patel. Paperback ISBN: 9780323694186 Book chapters: 16 1. Cheng MH, Nguyen DH, Huang JJ. Chapter 77: Vascularized Groin Lymph Node Flap for Treatment of Lymphedema. In: Perforator Flaps: Anatomy, Technique, & Clinical Applications. 2nd Edition. Blondeel PN, Morris SF, Hallock GG, and Neligan PC (Editors). Quality Medical Publishing, Inc. St. Louis, Missouri. 2013:1317-1328. 2. Cheng MH, Nguyen DH. Chapter 54: Lymph Node Transfer for Lymphedema. In: Operative Microsurgery. Boyd JB and Jones NF (Editors). McGraw-Hill, New York. 2015:672-682. 3. Tobbia D, Cheng MH. Vascularized Groin Lymph Node Flap Transfer for Post mastectomy Upper Limb Lymphedema. In Grabb's Encyclopedia of Flaps, 4th edition. Strauch B, Vasconez LO, Lee BT, and Herman CK (Editors). Wolters Kluwer, Philadelphia, PA, USA. 2015. 4. Tzou CHJ, Cheng MH. Transfer of lymph node tissue - my approach. In Oncoplastic and Reconstructive Management of the Breast: A Multidisciplinary Approach. CRC Press, Boca Raton, FL, 2015. 5. Cheng MH, Chang DW, Patel KM. Chapter 1: An introduction to principles and practice of lymphedema surgery. In Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. 2015 6. Nguyen DH, Cheng MH. Chapter 5: Laboratory study of lymphoma. In Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. 2015

瞭解更多手臂淋巴水腫的成因及症狀，以及為何安德森整形外科是您的安心選擇，有任何問題歡迎電話及線上諮詢。 Upper Extremity Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery What Is Upper Extremity Lymphedema? Breast cancer patients who underwent axillary lymph node dissection following radiotherapy are at a higher risk of developing extremity lymphedema – Breast Cancer-Related Lymphedema (BCRL), a condition that results in tissue swelling and liquid retention in the arms. While it is possible to manage the condition with some home care, surgery may be necessary to significantly improve an individual’s comfort and quality of life. Ming-Heui Cheng, MD, FACS, a pioneer in plastic microsurgery and internationally renowned lymphedema specialist, performs vascularized lymph node flap transfers on lymphedema patients whose symptoms have not improved or continue to worsen six months after they emerged. Symptoms Of Lymphedema Of The Arm The affected limb may develop inflammation, infection, adipogenesis, and fibrosis of the tissue. The protein-concentrated fluid that accumulates inside the interstitial tissue may further block or make the drainage of the lymph fluid less efficient or even create an obstruction. Lymphedema of upper extremity causes pain, heaviness, skin hyperkeratosis, fibrosis, discomfort when wearing certain clothes and jewelry, cosmetic problems and limitation of daily activities for patients. It is common for lymphedema patients to experience depression, due to physical discomfort, emotional distress and lower quality of life. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Surgical Techniques 1 Lymphaticovenous Anastomosis, LVA LVA is an advanced minimally invasive super-microsurgical technique used to relieve lymphedema. During the procedure, Dr. Cheng will make small incisions, which expose lymphatic channels and small veins just beneath the skin. Learn more 2 Vascularized Lymph Node Flap Transfer, VLNT In some cases, surgery may be performed to alleviate swelling and reduce symptoms. Dr. Cheng has developed a unique technique that involves lymph node transfer. During the procedure, Dr. Cheng transfers lymph node flap to distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity. Learn more Case 61-year-old female with breast cancer-related lymphedema in the right upper limb Before Surgery: This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. After Surgery: At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. 53-year-old patient, right upper limb lymphedema clinical grade II Before Surgery: A 53-year-old patient with grade II breast cancer-related lymphedema of the right upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. 39-year-old female, left upper limb lymphedema, grade 1 Before Surgery: This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. After Surgery: At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. 49-year-old female, right upper limb lymphedema, grade 1 Before Surgery: This is a 49-year-old female with right upper limb lymphedema for 6- months after right mastectomy and axillary lymph nodes dissection and radiation. After Surgery: At a 20- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 85% and 60% above the elbow and below the elbow, respectively. Recommended reading journal Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75 https://www.ncbi.nlm.nih.gov/pubmed/19337095 Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Plast Reconstr Surg. 2013 Jun;131(6):1286-98. https://www.ncbi.nlm.nih.gov/pubmed/23714790 Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Engel H, Lin CY, Huang JJ, Cheng MH. Ann Surg. 2017 Jun 7 https://www.ncbi.nlm.nih.gov/pubmed/28594742 Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. https://www.ncbi.nlm.nih.gov/pubmed/28507857 The Submental versus Groin Vascularized Lymph Node Transfer Flaps: A Head-to-Head Comparison of Surgical Outcomes for Breast Cancer Related Lymphedema Ho OA, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 [Epub ahead of print] Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

Our Service 認識更多我們的醫學美容服務：包括乳房美學、眼型美化、臉部美容、精緻體雕和凍齡科技 醫學美容 Our service 01 乳房美學 02 眼型美化 03 臉部美容 隆乳 縮乳 / 提乳 男性女乳症 乳頭整形 雙眼皮 & 眼型手術 眼袋 / 淚溝 / 黑眼圈 鳳凰電波 除斑淨膚 除痣 / 病毒疣 八倍淨膚雷射 04 精緻體雕 05 凍齡科技 威塑抽脂 外泌體

為維護良好的醫療品質與看診舒適，本院採預約制，您可先以電話、電子郵件、LINE或填寫線上表單等方式預約，我們會盡快與您聯繫！ Let's Connect How to Make an Appointment? To ensure high-quality medical care and a comfortable consultation experience, our clinic operates on an appointment-only basis. You can schedule an appointment via phone, email, LINE, or by filling out the online form. We will contact you as soon as possible! Business Hours: Monday to Friday, 8:00 AM to 6:00 PM. Closed on weekends. Notice Please download and complete the Client Information Form from our website. The information you provide will allow the A+ Surgery Clinic to select the most suitable team of specialists to assist you with your medical or personal needs. On the form, please clearly specify your preferred appointment dates as well as any special requests or personal needs that you may have. We will try our best to make you feel as close to home as possible. Please provide all detailed medical reports at least from the past 3 months, including lab or pathology reports and imaging files (X-rays, CT, MRI, Ultrasounds, Lymphoscintigraphy, etc.). If you have medical information, please provide it. Please send (1) and (2)to A+ surgery clinic at aplussurgery@gmail.com and Miffy Lin. Within two business days, A+ surgery clinic or Miffy Lin will contact you by email with further appointment details or medical questions once we receive and review your application form. Any information you provide will be kept strictly confidential under the Medical and Personal Data Protection Laws in Taiwan. Treatment Plan After gaining understanding of your medical background, our medical team will draft and present to you a treatment schedule specifically tailored to your personal needs. At the same time, a detailed statement describing the treatment process and estimated costs will be sent to you by email. Appointment Confirmation Once you have confirmed and accepted Dr. Cheng’s treatment plan, your medical coordinator will proceed to set up, double check, and confirm your previously made appointment date, as well as make the necessary travel visa preparations, airport pickup, and hotel accommodations for you, to make your stay with us carefree. Address 3rd Floor, No. 337, Fuxing North Road, Songshan District, Taipei City (MRT Zhongshan Junior High School Station) Map Phone (+886) 02-2712-3373 Phone (+886) 0966-523-737 Phone Email aplussurgery@gmail.com Social Media LINE Name Gender * Male Female Other Email Region * Taiwan Others Phone Convenient contact time 選擇一個時段 Remark Send Appointment successful ！

鄭明輝教授是經過國際專業認可的整形外科專科醫師，同時也是美國重建顯微外科學會2006年Godina獎得主，是第一位亞洲整形外科醫師得獎者。截至目前為止，鄭教授已經完成了2100多例顯微手術，包括頭頸部重建、乳房重建、顱內外動脈血管吻合手術、淋巴管靜脈吻合術和顯微淋巴結皮瓣移植手術。 Gallery Treatment of Mild to Moderate Lymphedema Lymphaticovenous Anastomosis (LVA) - Upper Limbs Case 1 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 57-year-old female with left upper limb lymphedema for 12- months after left mastectomy and radiation. At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 25% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 12- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 71% and 100% above the elbow and below the elbow, respectively. At a 15- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 86% and 100% above the elbow and below the elbow, respectively. Case 2 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 56-year-old female with right upper limb lymphedema for 10- months after right mastectomy and axillary 31 lymph nodes dissection and radiation. At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. At a 12- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 24- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Case 3 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 64-year-old female with left upper limb lymphedema for 12- months after right mastectomy and axillary lymph nodes dissection and radiation. At a 11- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 65% and 70% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 18- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 55% and 40% above the elbow and below the elbow, respectively. At a 24- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 90% and 50% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. Case 4 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. Case 5 Lymphaticovenous Anastomosis (LVA) - Upper Limbs This is a 49-year-old female with right upper limb lymphedema for 6- months after right mastectomy and axillary lymph nodes dissection and radiation. At a 6- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 80% and 50% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Upper Limbs At a 20- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 85% and 60% above the elbow and below the elbow, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs Case 1 Lymphaticovenous Anastomosis (LVA) - Lower Limbs This is a 50-year-old female with right lower limb lymphedema for 14 years after cervical cancer and radiation. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 40% and 30% above the knee and below the knee, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs At a 7-months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 25% above the knee and below the knee, respectively. Case 2 Lymphaticovenous Anastomosis (LVA) - Lower Limbs This is a 36-year-old female with left lower limb congenital lymphedema for 12 years. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 60% and 30% above the knee and below the knee, respectively. Lymphaticovenous Anastomosis (LVA) - Lower Limbs At a 12-month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 60% and 40% above the knee and below the knee, respectively. Case 3 After cervical cancer This is a 62-year-old female with bilateral lower limb lymphedema for 24-months after cervical cancer and radiation. At a 1 month of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 30% and 20% above the knee and below the knee, respectively. Case 4 After cervical cancer This is a 67-year-old female with grade I left lower limb lymphedema and grade IV right lower limb lymphedema for 14 years after cervical cancer and radiation. At the 16 days of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms and extremity tightness. Left lower limb was received.

Lymphedema FAQ for patients outside of Taiwan. Feel free to contact us if you have any other questions Prepare vascularized submental lymph node flap transfer surgery Q1 How long is the stay, to comfortably prepare for surgery and complete postoperative care? One week. Q2 At which hospital or facility would the surgery actually be performed? A+ Surgery Clinic has the state of art 42X Mitaka microscope, 3 operation rooms, and professional anesthesiologists, full-time RNs, and 7 private rooms for admission. Q3 Will you and your office coordinate all aspects of care? Yes. All of our patients are well cared for. Q4 Who will be the point person before, during, and after the surgery? Miffy Lin, Ph.D., chiayumiffy@gmail.com Q5 Do you have any logistical leaflet you could share that is aimed at international patients like us? No. You may check our website: www.lymphedemamicrosurgery.com Surgical procedure, from planning to post-operative care Q1 Do you need MRI, lymphoscintigraphy, and ICG, OR are one or two of those sufficient? If so, which is/are preferable in terms of balancing accuracy of diagnosis /surgical course vs radiation or other risks? Lymphoscintigraphy and ICG are required to make an accurate diagnosis and staging for the treatment, either LVA or VLNT. MRI does not help for the treatment. Q2.1 Before travel to Taiwan, are other tests (beyond imaging) needed to determine the appropriate surgical procedure? Please check platelet count, since the heparin-induced thrombocytopenia and thrombosis is the most common complications post VLNT, specially for those patients with heparin exposure such as the Port-A insertion for chemotherapy. Q2.2 Before travel to Taiwan, are there any medical records that we should be sending you? Surgical record, pathology reports, Lymphoscintigraphy and ICG. Q3 Upon arrival in Taiwan: what are the salient pre-operative steps? CBC/DC, Chest X-ray, EKG, Lymphoscintigraphy and ICG. Q4 Would you personally be performing the surgery, irrespective of the surgical path you deem best? I personally perform the surgery through the entire procedure. Q5 What other specialists, if any, would be part of my medical team? I personally perform the surgery through the entire procedure. Q6 How long does the surgical procedure itself last? LVA: 2 hours, VLNT 4-5 hours. Q7 How long is the hospital stay? LVA: 2 days, VLNT 5-7 days. Q8 How much pain should my reasonably expect and for how long? Not much pain immediate postoperatively, most patients do not need intravenous pain killer. Q9 What are the salient risks of undergoing the surgery itself? How likely are they? The heparin-induced thrombocytopenia and thrombosis (HITT) is the most common complication post VLNT, about 15 %, especially for those patients with heparin exposure such as the Port-A insertion for chemotherapy. HITT will develop the local pedicle artery or vein thrombosis, which will affect the survival and function of the VLNT. Infection is rare. Q10 What are the post-operative risks or adverse effects of the procedure? How likely are they? See above answer. Q11 Can you briefly describe anew (our notes are a bit confusing) the salient difference between your approach and the "main US alternative" we discussed (Cleveland Clinic)? The side-to-end lymphovenous anastomosis is the better drainage for extremity lymphedema without wearing compression postoperatively. The lymphatic vessels require contraction to push the lymph from distal to proximal, from dependent site to axilla. If the lymphatic vessels are divided and lost its continuity during end-to-end anastomosis, all the segments of lymphatic vessels will lose their continuity and contraction function, which lost the drainage function eventually. Q12.1 What are the key benefits of your approach compared to the main US alternative? Is your approach substantially less invasive than the main US alternative? Yes, one side-to-end LVA at the distal forearm is less invasive, no trauma to other healthy lymphatic vessels. No compression garments are required postoperatively. Q12.2 What are the key benefits of your approach compared to the main US alternative? Is your approach substantially lower risk? Yes. Q12.3 What are the key benefits of your approach compared to the main US alternative? Is the reduction in lifetime risk of infection/cellulitis substantially greater? Yes. Once the lymph has been adequately drained into venous system through side-to-end LVA daily, estimated 500 cc per day, the infection and cellulitis has significantly decreased. Q12.4 What are the key benefits of your approach compared to the main US alternative? Is the reduction in other lymphedema-related risks/co-morbidities substantially greater? Yes, mainly the infection, swelling, and appearance. Q12.5 What are the key benefits of your approach compared to the main US alternative? Is reduction in arm circumference substantially greater? Yes. Q12.6 What are the key benefits of your approach compared to the main US alternative? Is the absence of need for post-surgical compression unique to your approach? Yes. Q13 Taking into account the unique benefits of your approach, are there any countervailing potential risks or disadvantages that we should consider, relative to the main US alternative? No countervailing potential risks in side-to-end LVA. The temporary cosmesis in the distal recipient site, the potential HITT in VLNT. Q14 You indicated a 98% success rate for the procedure, which is remarkable and very comforting. Are there clinical indicators that can determine if my is at high risk of being in the 2%? If the ICG demonstrating the lymphatic vessels are available at the forearm. Q15 About post-operative care, what does the post-operative care in Taiwan involve? You may visit the testimonials of our patients via Youtube at https://www.youtube.com/watch?v=IINbv0xZdWQ , and https://www.youtube.com/watch?v=NwCw_SQnAPI . Q16 About post-operative care, once we are back home, is there someone you trust in NYC to collaborate with, so as to ensure any follow up care is performed to your standards of excellence? Dr. Joseph Dayan at Memorial Sloan Kettering Cancer Center. Q17 About post-operative care, how likely is it that we would need to travel to Taiwan anew for follow up care or procedures? One year post-operatively. Q18 Is there a risk that the two long flights from /to NYC might defeat the benefits of the surgery itself? No. I have quite a few international patients from US, Canada, Rusia, Sweden, Dubai, Saudi Arabic, India, and Iraq. Q19 I am on Anastrozole, Verzenio, Minoxidil. Are any of those of concern as it relates to surgery? No. Q20 Considering the most promising current /known avenues of research for an actual cure over the next 5 to 10 years, is the surgery likely to foreclose applicability of such potential cures? In my opinion, the side-to-end LVA can cure the early grade lymphedema, and VLNT can cure the late grade lymphedema without wearing compression garments. I think there may be some innovation for the treatment of lymphedema in the next 5-10 years. Managing symptoms & caring for my lymphatic system today Q1 How long is the stay, to comfortably prepare for surgery and complete postoperative care? We followed your advice not to bandage. Can you briefly provide anew the key rationale for your recommendation? (Please forgive our anxiety; bandaging seems to be the standard of care in the US.) Bandage and compression garments are not helping the drainage of lymph in the extremity daily. 10% of arterial blood become the lymph(estimated 500 cc /day in the upper limb) in the interstitial, then the lymph accumulates through the lymphatic vessels to axillary lymph nodes, which continuously drains to thoracic ducts, and to venous system. Bandage and compression garments will affect the contraction of the lymphatic vessels. Although the lymphedematous limb seems not swelling, but the lymphatic vessels will be fibrotic changed quickly. Q2 Are there demonstrably helpful non-surgical treatments or routines that I can start now to manage symptoms or protect her lymphatic system (e.g.: exercises, lymphatic massage by certified therapist, acupuncture, diet, arm elevation)? Exercises including yugo, biking, swimming and golfing within 3 hours each time are helpful for circulations. Lymphatic massage is helpful too. Please remember the lymph production is 10% of the arterial flow. Diet control is good. Arm elevation with one pillow during sleep is good. Financial aspects Q1 What is the all-in cost of the procedure? Please ask Miffy for the details of the cost of possible procedures. Q2 Is this cost fixed /guaranteed? Please ask Miffy for the details of the cost of possible procedures. Q3 Are you amenable to working with our insurance (BUPA in the United Kingdom) to ensure they provide us with pre-authorization, so that we can be reimbursed. We regret to inform you that we are unable to accept BUPA insurance policies at this time. However, we would be happy to discuss alternative payment options Get in Touch FAQS About Lymphatic System & Lymphedema

安德森整形外科使用通過衛福部檢驗，來自於人類臍帶幹細胞分泌的外泌體。這些外泌體具有分子小、純度高的特點，免疫排斥反應的風險較低，安全性更高。 革新醫療： 外泌體讓你健康與美麗兼得 Exosomes 外泌體的廣泛應用 再生醫學：外泌體在促進組織修復和再生方面具有巨大的潛力，已廣泛應用於創傷修復、骨再生和心臟修復等領域。 抗衰老：外泌體含有豐富的生物活性分子，能夠促進皮膚細胞更新和修復，改善皮膚質量，減少皺紋，延緩衰老。 免疫調節：外泌體能調節免疫系統，對抗炎症反應，有助於治療自體免疫疾病和慢性炎症性疾病。 安德森整形外科的 外泌體優勢 安德森整形外科使用通過衛福部檢驗，這些外泌體具有分子小、純度高的特點，免疫排斥反應的風險較低，安全性更高。 邀請您體驗外泌體的奇蹟 外泌體，這一細胞間通信的微小信使，正帶領我們進入醫療科技的新時代。安德森整形外科邀請您共同來體驗外泌體帶來的健康與美麗，見證更多奇蹟與希望。

鳳凰電波特色、探頭比較 ｜需要幾次療程？｜鳳凰電波與電波的差異｜術後保養和注意事項 ｜ 立即預約 與我們聯絡

皮秒雷射+防曬肌密評比，去除斑點、痘疤、胎記、刺青，告別小花臉，找回淨白無瑕高光美肌，不需遮瑕、不必修圖、不怕素顏見人！享受輕透裸妝感 除斑淨膚療程 Spot removal and skin clearing treatment 想要「修修臉」，哪種效果最好!? 皮秒雷射+防曬肌密評比 去除斑點、痘疤、胎記、刺青 告別你的小花臉~~找回淨白無瑕的少女感美光肌 不用遮瑕~不必修圖~不怕素顏見人~ 享受輕透裸妝感 皮膚的黑色素細胞組織受到環境、紫外線及內分泌等影響，就會讓膚色變黑，產生各種不同的斑點。各種斑點形成的原因不同，在皮膚呈現的深淺度也不同，醫師會根據病灶成因選擇適合的雷射機種來治療。 常見形成斑點的原因 1.紫外線曝曬，皮膚超級虐 太陽光的照射是造成斑點的頭號殺手，當肌膚受到紫外線長時間的照射時，就會啟動黑素細胞活性，進而產生黑色素(Melanin)保護肌膚。健康的肌膚狀況能隨著新陳代謝而淡化，但是當黑色素的生成平衡遭到破壞，或肌膚更新速度異常，導致黑色素過度製造及分布不均時，就會留下斑點或暗沉。 2.女性賀爾蒙黃體期，特別容易長斑 女性都有經期週期，每月排卵期到生理期來的這一段時間也稱之為黃體期（又稱分泌期），這時候身體會分泌大量的黃體素(Estrogen)，黃體素主要由下丘腦和腦垂體所控制，下丘腦和腦垂體除了分泌黃體素之外，也會伴隨分泌雌激素，雌激素是一種製造黑色素的賀爾蒙，因此當女性處於黃體期時，體內會分泌大量的黑色素，因此防曬就變得更為重要，一旦忽略，會比平時更容易黑色素沉澱形成斑點；懷孕的婦女受到賀爾蒙的影響也容易長斑，尤其在乳暈、腋下、鼠蹊等處，特別容易發生黑色素沉澱。此外，口服避孕丸及停經婦女，因為體內賀爾蒙發生變化，也容易造成黑斑或黑色素在皮膚生成。 3.皮膚受傷後的色素沉澱 當肌膚受到傷害處於發炎的狀態，此時體內會分泌大量的免疫激素來啟動防禦機制，許多研究已證實免疫激素如白介素-1(IL-1)、白介素-6(IL-6)及腫瘤壞死因子(TNF-α)等，都會刺激黑色素的活性，產生過量的黑色素就稱為發炎後色素沉澱Post Inflammatory Hyperpigmentation (PIH) ，當肌膚受傷或發炎，這時候此區域就會出現斑點，外觀多為棕色、褐色或深褐色，一旦忽略防曬、重複發炎或不治療，可能會永久存在且惡化。常見的PIH症狀如：蚊蟲咬傷造成「紅豆冰」、痘痘發炎擠壓造成痘疤、皮膚癬菌或病毒性發炎、接觸性皮炎引起的色素沉澱。 我的膚色比較暗沈，可以如何改善呢？ 脈衝光(IPL)或彩衝光是全方位的高能量光能照射治療法，它可以治療皮膚暗沈、改善膚色不均、淡化斑點、減弱細紋、縮小毛孔，使皮膚更緊實細緻，療程相對溫和，獲得許多女性的喜愛。 另一個選擇是皮秒雷射(Pico way)，主要是透過不同波長的雷射能量，改善像是黑色素沉澱、膚色不均、痘疤或深淺層斑點等問題。治療無開放性傷口，可快速修復。 我有雀斑，在兩邊顴骨應該如何處理？ 雀斑常見在眼睛下方、兩側顴骨處，較常發生在年輕女性，可以使用銣雅鉻或皮秒雷射治療，它可以震碎色素斑點，而黑色素代謝也較快。 長期曬太陽造成的曬斑，可以徹底清除嗎? 曬斑一般與陽光的照射及紫外線有關，常發生在臉部或手臂上。可以使用脈衝光、銣雅鉻或皮秒雷射治療。雷射後建議要做好防曬，包含物理性及化學性防曬，以避免反黑。 隨著年紀增長，臉部開始出現茶褐色老人斑，會越老越嚴重嗎? 老人斑又稱脂漏性角化症，是型態較多樣化的皮膚症狀，有深淺、平凸不同的呈現，常發生在中年時期，會發生在臉部或手上，可以使用鉺雅鉻雷射治療，或二氧化碳雷射處理，通常需要1~2次的治療，約一週雷射傷口就可復原。若是有單一顆或較大體積的老人斑，建議手術切除，專科醫師若懷疑老人斑合併惡性變化時，會建議使用手術切除並送病理化驗。 臉上長出大片肝斑，該怎麼辦? 肝斑好發於年輕、懷孕後女性，因為內分泌、荷爾蒙或壓力等問題，常見於額頭、顴骨、臉頰兩側等位置，為黃褐、暗褐色的大區塊片狀斑，邊界常不明顯、形狀不規則，呈對稱分佈。雷射可以用來治療很多色素斑點疾病，但對於肝斑的治療效果有限，在雷射部分可以使用脈衝光或皮秒雷射來淡化斑點，但雷射後容易反黑，需要小心防曬。目前的肝斑治療都只能控制，並無法完全根除肝斑。最重要的是要防曬以及維持健康的飲食作息。 臉上有「紅色血管瘤」好困擾，能根治嗎? 血管瘤外觀看起來是紅色的腫塊，主要是因為血管內皮細胞異常增殖以及血管結構異常所產生，可以使用染料雷射治療，有冷卻系統配合比較不痛，此方法也可以用來治療臉上微血管擴張造成的血管絲及改善黑眼圈，是目前血管雷射治療的最佳選擇。 雷射術後「不反黑」的保養秘訣 1.溫和清潔 雷射手術後角質會變得較敏感，對於空氣中的髒污及塗擦防曬產品，還是需要確實的清潔。但因為雷射手術後有可能會有一些微創傷口，建議選擇敏感肌膚使用的卸妝水和不含皂鹼的洗面乳，溫和的清潔肌膚。 2.鎮定舒緩 可以使用許多醫美品牌所推出的「礦泉噴霧」當作化妝水使用，因為活泉水中有含豐富的礦物質，可以讓肌膚退紅且鎮定舒緩，肌膚感到乾燥時就可以隨時拿起來使用，相當方便 3.保濕修護-精華液 雷射手術後的保濕、修護相當重要，選擇含有保濕修護功能的精華液，可以有效幫助肌膚修護再生，使肌膚復原得更加快速。 4.長效鎖水保 濕 使用保養品前可以先敷生物型保濕面膜，能使肌膚加快吸收保養品。再使用乳液或乳霜這類保濕成分較高的產品，不只保濕還可以鎖水，把所需要的營養鎖在肌膚裡。 5.防曬一定要做好 此段時間的肌膚較敏感，受紫外線刺激可能會產生大量的黑色素，造成手術後的所謂「反黑」問題。因此防曬相當的重要，依據肌膚狀況使用不同的方式做防曬，如使用物理性防曬或防曬產品，也請不要讓肌膚直曬太陽。 雷射術後避免使用的保養品 1.抗痘效果的保養品 2.各種酸類保養品，例如：杏仁酸、果酸、水楊酸等成分 3.有煥膚功能的保養品 4.美白成分的保養品 5.含酒精成分的保養品

Patient Testimonials Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 病患感言 病患感言 Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search videos Search video... Now Playing Lymphedema Treatment Testimony: Canadian Patient at A+ Surgery Clinic, Taipei, Taiwan"Video Content: 09:51 Play Video Now Playing Lymphedema Treatment Testimony:In addition to excellent medical care, also enjoys Taiwanese cuisine 04:27 Play Video Now Playing Mr. William from Australia 05:50 Play Video