1.

²�(q�Q 67 yo
Right breast cancer s/p adjuvent therapy MRM and remove 7 LN, CT, RT, in 201401
Right upper limb lymphedema, right chest wall lateral capsule with seroma,finished
target therapy
-Rt carparl tunnel release, Rt total knee replacement
-lymphoscintigraphy: right upper limb total occlusion
-LG: T6, more sweeling than 4 years ago
=> discuss the surgery; Plan for Right VSLN to right dorsal wrist
===============
2.���v�v 49 yo
-Right groin mass 1 cm excised 2008, low grade histocytoma, s/p XRT, ,
dermatofibrosarcoma protuberans
-Lymph edema s/p VSLN transfer on 20150420, removed hematoma on 0504; Revision
surgery(removed part of the skin paddle) on 20160714
=> regular follow up
===============
3.��43 �‫ ت‬yo
1.Invasive ductal carcinoma of left breast; pT1cN0(s)M0; triple negative; Ki-
67:90%, status post partial mastectomy, s/p 6-cycle chemotherapy with
cyclophosphamide, epirubicin and 5-fluorouracil on 20170911
2.Right ductal carcinoma in citu status simple mastectomy and sentinel lymph node
biopsy 20170911
3.Status post 3 courses of adjuvant chemotherapy with taxotere

=> * fresh case in PS, never visit us before

==================
4.�3����� 63 y.o
1.Pulmonary embolism in right pulmonary artery
2.IVC thrombosis, from undetermined source
3.Right lower limb lymphedema with total occlusion s/p right VSLN transfer in
2015/10/26
4.history of bladder rupture
5.cervical cancer s/p debulking surgery and radiotherpay in 1998
6.DM without the medication

=> cellulitis in 2018/7, regular follow up

=================
5.�f�K�� 67
1.Left breast invasive ductal carcinoma s/p DIEP 20140627, pT2N0M0, stageII, ER(+),
PR(+), Her-2-neu(2+), Ki-67:10%
2. for Cervical cancer Ib s/p LARVH, then VSLN transfer on 20121213, revision on
20140321
2.Diabetes mellitus, under medication

=> for US report

US of left ankle VSLN flap:

Two lymph nodes found in the flap: 4.9x1.9mm, 4.7x2.5mm

Edematous change in left ankle VSLN flap and calf.
Severe scarring causing posterior acoustic shadowing and obscured vascular
anastomosis.
Suspected patent flow in flap veins.

IMP:
Severe scarring at left ankle VSLN flap. Difficult to evalute vascular
anastomosis. Suggest CTA correlation.
Two lymph nodes in the flap.
==================================
6.�H�ʤs 62 yo
1. Infiltrating urothelia carcinoma s/p 20110516 nephroureterectomy, left
2. Left leg posterior compartment defect s/p VL MC flap transfer
3. DM

-LG dermal back flow in the left leg, partial obstruction, P2

=> regular follow up for the left leg swelling

===================================
7.��� 60 yo
1.Left lower limb swelling for 2 yrs, s/p lung ca stage 4 with spine meta, 2015,C/T
XRT
2.Prostate cancer, adenocarcinoma, Gleason score 4 + 5 = 9 (2014/08), with T1
osteoblastic bone metastasis
- Doppler: no arterial stenosis, DVT or reflux
CT: Right 7401.535cm3; Left 10206.846cm3
Cellulitis on January
=> under compression garment, follow up for discussion
===================================
8.�S���R�� 79
Cervical cancer s/p
Right lower limb lymphedema, VSLN transfer on 20140307, revision surgery 20160708
TIA hisotry
Hyperparathyrodism s/p parathyroidectomy on 20161004

-Lymphascitigraphy showed no active lymph node. CTA showed grossly patent arterial
and venous anastomosis but surrounded by scar tissue.
Suggest further revision of the pedicle vein but the patietn refuse
-uticaria episodes

=> follow up for discussion and the skin lesion (uticaria)

======================
9. ��z�� 37 yo
2018-08-28 OP: Texture round implants (Allergan Style 110)right side 270cc and left
side 270cc

=> post op 3 months follow up

=====================
13.�L�,� 63 yo
History of endometrial cancer s/p ATH, XRT iun 201
Secondary lymphedema of right lower limb s/p omental VSLN flap transfer on
20161227, then revision surgery on 20180622
Right common iliac vein stenosis s/p stenting in 2016-3
Hypertension

- INR 11/5 : 1.5 (previous 2.0) under warfaring for iliac vein stenosis?
=> post revision 5 months follow up
====================
14.�P�m�� 41 yo
post kidney transplantation since 10 years ago,
left lower leg lymphedema s/p double VSLN 20170518, then revision surgery on
20180830
.ESRD status post renal transplantation
.Hypertension
.Hepatitis B carrier

=> post revision 3 months follow up

==================================
15.����� 31 yo
right neck swelling since 2018/9
acute lymphadenitis was told at LMD ;mild swelling over the zone II, discomfort
under palpation, only Rt side
fever once
- 20181120 echo guided biopsy :14.7x6.3 mm oval hypoechoic nodule in right neck
level II with preserved fatty hilum, suggesting a reactive lymph node; bilateral
thyroid colloid cyst
Negative for carcinoma. Suggestive of lymphoid hyperplasia.

=-> for echo biopsy report

====================================
16.�\�ʑ@ 49 yo
Right inguinal sarcoma, synovial sarcoma s/p excision + DIEP rotational advancement
flap
on 20151005 (patho:suspicious for low-grade spindle cell sarcoma with bony
metaplasia)
immature squamous metaplasia of uterus s/p LAH on 20170525
-CLG grade 3, LG: right lower limb T4, last time we arranged the pre op evaluation

MRA of neck without and with IV contrast media enhancement shows:

1. Course of facial artery:

-Bilateral facial arteries passing above the submandibular glands then go to
cheek.
2. LNs in the level Ib:
R: 3.3x1.6mm, 8.7x5.6mm, 9.3x5.3mm.
L: 7.1x5.6mm, 9.9x8.0mm, 5.4x3.5mm, 4.4x2.3mm
3. Unremarkable in the visceral space of neck and visible brain.

Impression:
S/P submental LN flap evaluation.
- Bone scan : negative finding Lower C-spine lesion, probably degenerative spine
disease.
Bilateral shoulder and knee joints arthritis.

=> discuss then arrange VSLN flap transfer

=====================================
18.����� 61 y.o
right lower limb lymphedema for 10 years,
cervical ca s/p RTH, XRT, PLND since 20 years
2017-3-23 OP: left vascularized submental lymph node flap transfer to right ankle
-mild infection and swelling, need admission for IV antibiotic. But the patient
refuse to be admitted to the hospital.

=> already received penicillin G 3 times, f/u the cellulitis condition

======================================
19.��ģ�x 45 yo
mild infection and swelling, need admission for IV antibiotic. But the patient
refuse to be admitted to the hospital-> visit Dr yang on 20180706
=> fresh case, never visit us before

=====================================
20.�B�p�� 26 yo
hypertrophic breast s/p liposuction of back and bilateral arms 1 year ago
20181109 bilateral breast reduction

=> post op 3 weeks follow up

=====================================
21.�L�R�� 25 y/o
bilateral lower limb swelling for 1 year
no episode of cellulitis
no cancer history
lymphoscintigraphy done at Mackay hospital showed partial obstruction on left lower
limb, patent at right side
op: tonsillectomy in childhood

- in 2018/5 ICG reviewed, no suitable lymphatic duct for LVA. Recommended VSLN.
Patient will discuss with family.

=> keep conservative treatment previsouly, regular f/u

=======================================
22.���O�T 64 y/o
left leg swelling for 30 yrs
PI: cellulitis episode every 2-3 years, require admission at �Ӳ�H
- LG, CTA, ICG report

=> LG: P2
=> CTA
1. Lower limb:
-Minimal cutaneous thickening and subcutaneous fat hineycombing in left lower
limbs without definite fatty hypertrophy. Tortuous venous structures in left
calf with large venous perforator, suggesting varicose vein. Patency of the
bilateral iliofemoral veins, iliac veins and IVC.
-Volume:
Right 8300.404 cm3
Left 8758.106 cm3
2. Visible abdomen: Unremarkable.
3. Visible bone: Mild degenerative change of spine.

Impression:
Not classicle appearance of lower limb lymphedema.
Varicose vein in left calf. Patency of the bilateral iliofemoral veins, iliac
veins and IVC.

**Suggest survey venous cause of limb swelling.

=> for report

====================
24.����X 64 y/o
left breast cancer s/p MRM and Left wrist preventive lymphovenous anastomosis on
20181120
(Side-to-end anastomosis completed in typical fashion, 7 stitches)
=> postop 2 weeks follow up
==============================
25.�L��� 48 y.o
right breast cancer s/p MRM and immediate reconstruction with cohesive gel implant
in 2015
remove left breast previous implant, scar release of right breast and axilla, left
DIEP flap transfer to right breast including the superficial lymph node (Dr. Masia)
on 20160429
then left mastopexy + fat graft in 20170411

=> regular follow up

===============================
26.�L�_�y 50 yo
colon cancer s/p Laparoscopic Anterior resection and anastomosis(sigmoid colon
resection) PLND (0/35), no CCRT in 20170630
Left leg swelling intermitently for one month.
-LG: No definite lymphatic obstruction in the bilateral lower limbs, Taiwan LSG
stage L0.
-ICG:Suspect early stage of lymphedema, abnormal lymphatic ducts over the Rt
leg(but lack ICG data post injection 21 hours)
- SPECT :Visualization of bilateral inguinal/femoral, bilateral exteral iliac,
bilateral
common iliac, bilateral retroperitoneal nodes/tracts.
20181123 LG No definite lymphatic obstruction in the bilateral lower limbs, stage
L0.

=> discuss the latest LG and SPECT report

=================================
27.�4_�� 62 yo
right lower limb swelling for 2 years
no previous operation, no cellulitis episode
20160429 op: 1. Laminectomy, L1-5 2. Foraminotomy, L1-S1
3. L2-3 and L5S1 TPS with Syntec, PL fusion with autograft bone
20170209 op: VSLN to right ankle
20180306 op: revision
-last visition on 20181029 still erytheroderma but improved . Received 3rd
penicilin injection then keep oral abx

=> follow up for the cellulitis condition

===================================
28.��q�� 72 yo
Cervical cancer s/p in 1990
left leg swelling 2-3 years after op, (about 20+ years) s/p Rt VSLN to left ankle
20160602
left leg chronic wd excision on 20181016

=> regular follow up

====================================
29.�B�_�Z 56 y/o

new patient
====================================
30.�L�¼z 19 yo
Hypogenesis of the vagina, s/p combinded surgery: Laparoscopic metroplasty, left
bucal mucosa
with Goretex graft transfer for neo-cervix reconstruction + External pudental
artery perforator flap then tubing for neo-vagina reconstruction on 20181005

=> discuss the scar release for scar contracture of the entrance of vagina
===============================
32.�P�l�� 48 yo
left chin subcutaneous tumor
20181127 operation: subcutaneous tumor excision

=> post op one week follow up

=============================
33.�i�ɸ�
right upper neck fibrosis s/p fibrolysis 30+ years at ��ƨq��
with chronic right neck swelling after operation
Childhood hemangioma? s/p op, worried about intracranial lesion,request further CTA
evaluation.
CTA showed
1. No definite arterial lesion on this CT angiography basis.
2. Right inferior parietal scalp nodule (2 cm). Suggest clinical correlation.

=> Fresh case in our clinic, refer from Neurologist ?

===============================
34.���f�� 35 y/o
right breast cancer stage 2 treated in 2014 at Taipei Medical University Hospital
MRM+RT+chemotherapy lymph node dissection 1/27. Rt breast scar contracture
Left breast augmentation
**
20181122 operation :
Rt breast DIEP flap reconstrauction after scar release
Left breast augmentation was done Mentor smooth implant 175 cc moderate plu
profile, subglandular plane via midline endoscopic assisted

=> post op 1 week follow up

==================================
35. CHEN LI CHUAN 57 y/o
left breast implant rupture ( textured silicone implant, size unknown )
20181127 operation :bilateral implant removal, capsulectomy

=> post op 1 week follow up

==================================
36.�Q�d 52 y/o
painful swelling over wrist or DIP of hand joint with each episode lasting for few
days off a
s/p excision of vulvar tumor for one year by GYN, hands stiffness and pain, pain
over left hip

=> fresh case, never visit our clinic

===================================
37.�d�L�q�K 85 y/o
1.Left lower limb lymphedema 2014-0609: VSLN flap transfer
2.Cervical cancer s/p RTH, XRT 26 years ago
3.Coronary artery disease s/p stent 6 years years ago
4.Diabetes mellitus

=> The pt lost follow up for 2 years , last visit 20160926

====================================
38. International pat
Implant rupture-> debride then insert the new implant

=> schedule the surgery tomorrow

==================================

43.�]�Y�Y 37 yo
NS breast implant 18 years ago
Bilateral breast implant(�G�ᪿᪿᪿ)
�� 10 year ago but felt size too large
switch to smaller bilateral implant(�G�ᪿᪿᪿ)
�� 8 years ago, total 4 times of
augmentation

20181115 : removal of bilateral implants

=> post op 1 week follow up