在安德森內搜尋：

了解更多有關術後照顧的重點，患者不再需要穿戴壓力袖套、襪，但建議患者在術後接受3~6個月的復健，需要積極治療。 Post-Operative Care Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Post-Operative Rehabilitation The A+ Surgery Clinic provides comprehensive and extensive medical services before and after surgery. It is recommended that lymphedema patients receive post-operative rehabilitation for a period of 3- 6 months. It is most noteworthy that patients no longer need to wear compression garments after Dr. Cheng’s Side-to-End Lymphovenous anastomosis and vascularized submental lymph node flap transfer to distal recipient site for post-operative rehabilitation. It is recommended to massage from the proximal limb to the distal site for 15 minutes 3 times a day one month post-operatively for 3 to 6 months to further improve lymphatic drainage. Post-Operative Follow-Up The lymphedema of both upper and lower extremities can cause pain, discomfort, fibrosis, cosmetic problems, and mobility restraints for patients. It is common that lymphedema patients develop various degrees of depression due to physical discomfort, disfiguration, and emotional distress. With an average of a 2-year follow up after undergoing microsurgical microsurgery including Side-to-End Lymphovenous anastomosis and vascularized lymph node flap transfer to distal recipient site, the affected limb become softer overtime. 90% of lymphedema patients have seen size improvement with a mean circumferential difference of 50%. With the physical improvement, patients are subjectively pleased to resume daily activities and life styles they used to have. After vascularized submental lymph node flap transfer, you are asked to comply with the rehabilitation program, which includes progressive lower limb muscle strength training and reverse manual proximal (groin) to distal (ankle) lymphatic drainage. You are encouraged to gradually massage the flap, scar, and control body weight control starting after discharge. Reverse manual lymph drainage and flap massage are performed for 15 minutes/time, 3 times daily. You are advised to return to normal activity gradually as tolerated, and all other physiotherapy and compression wrapping are discontinued. Vascularized submental lymph node flap is placed on the wrist in accordance with the “pump” mechanism and effects of gravity. You do not need to wear a compression garment or bandaging after surgery but are allowed to wear a wrist brace or wrist support to hide the scar on the wrist after the wound complete healed. Another revision surgery to remove the skin paddle and superficial fat of the transferred flap to improve the cosmetic appearance and simultaneous liposuction of the thigh to decrease the production of lymph is recommended after 1 year of vascularized submental lymph node flap transfer. 1. Reverse manual lymph drainage: Time: Performed for 15 minutes/time, 3 times a day, from groin to flap. Method: Medium strength massage that compresses the skin, subcutaneous, fat and muscle in proximal (groin) to distal (flap) direction. This helps encourage drainage of the lymph drainage through the lymph flap and appropriate channels. 2. Flap massage: For increasing the venous drainage of lymph node flap pumping Time: Performed for 15 minutes/time, each 3 times daily. Method: Medium strength massage to pump lymph node flap and the scar around flap. 3. Body weight control: Time: Check body weight every day. Lighten your weight if your Body Mass Index(BMI) over 25. 4. Infection/cellulitis prevention and control: Most healthcare-associated infections are preventable through good hand hygiene. It’s important to identify and treat cellulitis early because the condition can spread rapidly throughout your body. Red area or “New red spots” of skin that tends to extend from distal to proximal Swelling Tenderness Pain Fever over 38.5℃ After the initial postoperative period, you are seen on a monthly basis by sending images. You may use any communication apps, such as Line, WhatsApp, Skype, e-mail or WhatsApp. Surgical outcomes are evaluated by your subjective improvement, circumferential measurements, the frequency of cellulitis, and via patient reported health-related quality of life outcome metrics. We will arrange ultrasonography, CT, and lymphoscintigraphy for checking the number of the lymph node on the flap, lymph node function and volume of the arm after one year.

一旦您確認並接受了鄭教授的治療計劃，您的醫療協調員(個管師)將聯繫您，仔細檢查並確認您之前預約的日期。國際患者我們將為您做好必要的旅行簽證準備、機場接機和酒店住宿，也會讓您與我們方便聯繫。 Travel Visa What is a visa? A visa is a permission certificate or a stamp on a non-citizen applicant’s passport to enter a particular country. To apply for a visa to Taiwan, please visit a Taiwan Representative Office nearest to you. Types of Visas to Taiwan: Visitor, Business Visa: (effective for 7 to 30 days) A U.S citizen doesn't need a visa to visit Taiwan for up to 30 days. Please apply for your visa before your arrival in Taiwan, if you are not a U.S. citizen. For most patients, a visitor visa should offer sufficient time to undergo most kinds of medical checkups, examinations, and treatments. In the event that you are required to stay for longer than one month, we will assist you in applying for a medical visa. A formal certificate of diagnosis will be provided to you for the request of time extension for a medical visa. Landing Visa / Visa Exemption Please complete the immigration card WHILE on board the incoming flight. Citizens of some countries are eligible for a landing visa or visa exemption, which permits individuals to enter Taiwan without prior visa application for a duration of 30 to 90 days. Please click on the link on landing visa for more information. Please click on the link on visa exemption for more information. Entry Permit for Certain Passport Holders For citizens of certain countries, such as Pakistan, Iraq, Myanmar (Burma), Ethiopia, Nigeria, and Afghanistan, a formal medical visa letter signed by our hospital’s doctor will be required to gain entry into Taiwan. Travel Information Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Once you have confirmed and accepted your treatment plan, we will contact you to double-check and confirm the dates of your previous appointments. We will prepare the necessary travel visa, airport pick-up and hotel accommodation for you, and also make it easy for you to contact us. Travel Destination Known as the “heart of Asia”, Taiwan is packed with exciting things to do, beautiful sights to see, amazing food to try, festivals to enjoy, and friendly people to meet. Taiwan is famous for its landscape, rich heritage, diverse folk traditions, mild climate, magnificent temples, and numerous national museums. It has become a very popular travel destination in Asia because of its convenient and efficient transportation system, safe and secured environment, kind people, and affordable cost of travel. Taiwan’s unique tourism attractions – the combination of traditional Asia and the modern world, the contrast between metropolitan and countryside, the blending cultures of the old and the new, stunning scenery of mountains, coastlines and valleys, and tasty local food and international cuisines – bring tourists back to this beautiful island year after year. Taipei 101 Located in the finest district Taipei has to offer, TAIPEI 101 is the largest engineering project ever in the history of the Taiwan construction business. At 382 meters above the ground the 89F Observation Floor offers visitors a commanding view of the city and Taipei Basin at all directions. Yehliu Geopark Yehliu Geopark is truly a park of natural wonders: rocks carved by wave-cutting and weathering over years and years were formed into shapes resembling figures that are real. The most famous one is of course the Queen’s Head, among other “statues” that are named the Fairy’s Shoe, the Mushroom Rocks, the Tofu Rocks, and the Elephant Rocks, along with many interesting potholes. Do not forget to bring your camera. Sun Moon Lake The Sun Moon Lake National Scenic Area is praised for its five major recreational systems, including the lake, Shueili River, Puli, Jhuoshuei River, and Jiji. The surrounding areas stretch to cover known tourist spots including Taumi, Checheng, Jiji, Shueisheda Mountain, Sangyong Falls, Mingtan Reservoir, and Shueili River. Sun Moon Lake features the only full-range 3D tours (lake, sky and land) in Taiwan. The lake cycling trail has been recognized by CNNGO, CNN as one of the most beautiful cycling trails in the world. *Travel Visa Information : National Immigration Agency www.taiwan.net.tw Taroko National Park Taroko is famous for its spectacular mountains and marble canyons. Cliffs and canyons stretch along Liwu River. The waterfalls characterized Taroko National Park and the most famous ones are Baiyang Waterfall, Yindai Waterfall, Changchun Waterfall, and Lushui Waterfall. Swallow Grotto (Yanzikou) and Tunnel of Nine Turns (Jiuqudong) are the most impressive natural scenes in Taroko and the canyons here are the narrowest.

GENERAL INFORMATIONS 2024 WSLS Symposium Program Venue Symposium Location: 2F, Taipei Garden Hotel (No. 1, Section 2, Zhonghua Rd, Zhongzheng District, Taipei City, Taiwan) 台北花園大酒店 Taipei Garden Hotel Learn more Taipei 101 Located in the finest district Taipei has to offer, TAIPEI 101 is the largest engineering project ever in the history of the Taiwan construction business. At 382 meters above the ground the 89F Observation Floor offers visitors a commanding view of the city and Taipei Basin at all directions. Yehliu Geopark Yehliu Geopark is truly a park of natural wonders: rocks carved by wave-cutting and weathering over years and years were formed into shapes resembling figures that are real. The most famous one is of course the Queen’s Head, among other “statues” that are named the Fairy’s Shoe, the Mushroom Rocks, the Tofu Rocks, and the Elephant Rocks, along with many interesting potholes. Do not forget to bring your camera. Sun Moon Lake The Sun Moon Lake National Scenic Area is praised for its five major recreational systems, including the lake, Shueili River, Puli, Jhuoshuei River, and Jiji. The surrounding areas stretch to cover known tourist spots including Taumi, Checheng, Jiji, Shueisheda Mountain, Sangyong Falls, Mingtan Reservoir, and Shueili River. Sun Moon Lake features the only full-range 3D tours (lake, sky and land) in Taiwan. The lake cycling trail has been recognized by CNNGO, CNN as one of the most beautiful cycling trails in the world. *Travel Visa Information : National Immigration Agency www.taiwan.net.tw Taroko National Park Taroko is famous for its spectacular mountains and marble canyons. Cliffs and canyons stretch along Liwu River. The waterfalls characterized Taroko National Park and the most famous ones are Baiyang Waterfall, Yindai Waterfall, Changchun Waterfall, and Lushui Waterfall. Swallow Grotto (Yanzikou) and Tunnel of Nine Turns (Jiuqudong) are the most impressive natural scenes in Taroko and the canyons here are the narrowest.

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。

Lower Extremity Lymphedema 下肢淋巴水腫：成因與症狀、淋巴水腫診斷、治療方式 What is Lymphedema of The Legs? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lower Extremity Lymphedema? The lower extremity lymphedema has a 10-49% occurrence in patients who suffer from gynecological cancers with pelvic lymph node dissection and radiation. Higher body mass index, a greater number of pelvic lymph node removal, and radiation are the top risk factors for lower extremity lymphedema caused by parasite infection (Filariasis). Primary lymphedema patients with unknown etiology for symptoms and signs are categorized by their ages of onset as congenital (less than 2 years), lymphedema praecox (2- 35 years), and lymphedema tadar (older than 35 years). The incidence is higher after cancer resection and lymph node dissection in vulva cancer followed by cervical and ovarian cancer. Recently, sentinel lymph node biopsy was selectively applied in gynecological cancer surgery to reduce the lower limb lymphedema. Symptoms of Leg Lymphedema Lymphedema then presents as chronic changes and swelling of the tissue and is often associated with adipogenesis or fibrotic changes in the lower limb as well. Severe fibrosis occurs with long-standing lymphedema due to the accumulation of protein-rich fluid in the interstitial spaces coupled with inflammation repeated bouts of cellulitis. It is common for lymphedema patients to experience depression, due to the physical discomfort, emotional distress and lowered quality of life. Diagnosis of Leg Lymphedema Dr. Ming-Huei Cheng developed a Cheng’s Lymphedema Grading tool to assess the severity of extremity lymphedema. Cheng Lymphedema Grading System is currently the most common used measurement, it is based on not only subjective criteria and clear objective findings that could facilitate discussions and meaningful comparison of the treatment proposed. The circumferential measurement is an objective analysis tool to assess the severity of lymphedema commonly by comparing the circumferential differences between the lymphedematous limb and the normal limb. Lymphoscintigraphy, computed tomography (CT), indocyanine green (ICG) lymphography, and magnetic resonance imaging (MRI) are other key diagnostic devices to determine the severity of lymphedema. The lymphoscintigraphy has been reported as the most effective indicator with 96% sensitive and 100% specific conclusion for diagnosing extremity lymphedema. The Taiwan Lymphoscintigraphy Staging systems was published in 2018 at Annals of Surgery. Lymphoscintigraphy computed tomography (CT) magnetic resonance imaging (MRI) indocyanine green (ICG) lymphography Treatment of Lower Extremity Treatments of lymphedema are aimed to control infection, to reduce the swelling of the extremity and to improve the quality of life. Basic treatments of lymphedema start with conservative physical therapy, including manual lymphatic drainage and compression bandage-centered decongestive lymphatic therapy. The efficacy of conservative physical therapy presents only when the patients are compliant with the treatment program. However, it also carries risks of intravascular cancer metastasis and thrombosis formation. Surgical treatments are indicated when first line conservative measures fail and when patients present with late stage disease. There are two main categories of surgical treatment: excisional and physiologic procedures. Excisional procedures are essentially a surgical reduction of excess fibro-adipose tissue in the affected limb while physiologic procedures reconstruct the lymphatic system to improve physiologic drainage. Surgical treatments are also “be cure and control”, the goals of treatment are similarly preventing progression of disease and reducing morbidities. Debulky surgery and circumferential suction-assisted lipectomy can be performed to reduce the severely, non-pitting lymphedematous extremity. More technical demanding surgeries, such as lymphaticovenous anastomosis and Free vascularized lymph node transfer The basic physiologic mechanism of the vascularized lymph node flap is that lymph is absorbed by the transferred lymph nodes and drained into a donor vein through natural lymphaticovenous connections inside a flap. The arterial flow from the recipient artery to the vascularized lymph node flap provides the driving force for venous return and hence, continuous lymph drainage. We report the transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumfer- ence was 64±11.5% above the knee, 63.7±34.3% below the knee and 67.3±19.2% above the ankle. All of the patients did not use compression garments post-operatively! 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. Recommended reading journal 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. Gynecol Oncol. 2012 Jul;126(1):93-8. https://www.ncbi.nlm.nih.gov/pubmed/22516659 Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure. Ito R, Lin MC, Cheng MH. Plast Reconstr Surg Glob Open. 2015 Sep 15;3(9):e513. https://www.ncbi.nlm.nih.gov/pubmed/26495226 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. https://www.ncbi.nlm.nih.gov/pubmed/29572824 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. https://www.ncbi.nlm.nih.gov/pubmed/30020232 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

專業麻醉醫師團隊，手術更安心。 認識蕭斯云 醫師和馮育斌 醫師 和他們的專業背景，讓您以及家屬都能放心 A professional team of anesthesiologists, making surgery safer Our team is professionally licensed and every operation is fully monitored, giving you and your family peace of mind. 蕭斯云 醫師 學歷 中國醫藥大學 醫學系 經歷 台北國泰綜合醫院 麻醉科 住院醫師&總醫師 台灣麻醉醫學會 專科醫師考試合格 衛生福利部立金門醫院 麻醉科 主治醫師 台北國泰綜合醫院 麻醉科 兼任主治醫師 沐美診所 麻醉主治醫師 三重宏仁醫院 麻醉科 兼任主治醫師 馮育斌 醫師 學歷 國防醫學院醫學系 經歷 台中榮民總醫院麻醉部住院醫師 台北國泰綜合醫院麻醉科主治醫師 日本東京醫科齒科大學齒科麻醉科研修醫師 汐止國泰綜合醫院麻醉科主治醫師 專長 兒童牙科門診鎮靜 成人牙科門診鎮靜 整形外科麻醉 產科麻醉 現職 舒美麻醉醫療團隊主治醫師

METHODS OF PAYMENT Only credit cards (Visa, MasterCard) will be accepted. Once payment has been confirmed, a summary of the registration will be sent to you via email. CANCELLATION All cancellations must be notified in writing (by email) to the Registration Secretariat (2024wsls@gmail.com ). The following rules will apply: • Cancellations received in writing within 31st March, 2024 are entitled to 100% refund • Cancellations received in writing between 31st March and 15th April 2024 are entitled to 50% refund • Cancellations received from 15th April, 2023 - no refunds • All refunds will be made within 3 months after the end of the event. Requests submitted after this period will not be considered. This Cancellation Policy is also applicable to Social Events payments. FOREIGN VISAS For information on what to expect if you are applying for review the Visa Application Guidelines, please visit https://www.boca.gov.tw/cp-149-4486-7785a-2.html . The 2024WSLS can provide documents that will document your participation in the 10th World Symposium for Lymphedema Surgery. Please note that the 2024 WSLS cannot interact with Embassies or State Departments on behalf of any participant. Official Letter of Invitation for Meeting Attendees: To request a personalized letter of invitation for the 10th WSLS, please send an email to 2024wsls@gmail.com and include "2024 WSLS Visa Request" in the subject line.

揮別壓力衣！鄭教授的獨門顯微手術，改善淋巴水腫帶來的不適，了解不同淋巴水腫治療方式的比較及安德森的專業