Interosseous Membrane Release for Long-Standing Upper Limb Lymphedema: A Procedure Often Neglected

1 T incidence of secondary lymphedema in breast cancer patients, undergoing axillary node dissection or postmastectomy irradiation, is increasing up to 30%, despite the improvement in diagnosis and treatment.1 Once lymphedema occurs, they are being treated by general surgeons and plastic surgeons. Ninety percent of patients with lymphedema respond to conservative treatment and do not need surgery. However, some of them may develop advanced lymphedema, leading to multiple functional problems. Currently surgery is being reported to improve limb size, sensation of heaviness, and rate of infectious episodes, so that both patients and surgeons are satisfied enough with good control of cancer as well as lymphedema.2 However, with extended life expectancy of breast cancer survivors, optimum upper limb function is important for a higher quality of life. When there is long-standing lymphedema, the interosseous membrane can become fibrotic, with limitations in hand movement, especially supination of the forearm. Delayed washout of chemical mediators, as well as increased pressure, contributes to persistent swelling and chronic pain. Prolonged high protein edema creates an environment conducive to infection. Joint stiffness due to lymphostatic tendinosis or ligamentosis can occur.1 To improve torsional rigidity of the forearm during pronation and supination, we suggest releasing of the forearm interosseous membrane. Performed through a distal to proximal longitudinal surgical incision, it allows the muscle masses to enlarge and redistribute, reducing intracompartmental pressure. The procedure is usually undertaken as part of other aggressive surgical debulking therapies, such as massive suction-assisted lipectomy, or radical reduction with preservation of perforators localized dermolipectomy.3 The incision starts in supination forearm, lateral to biceps tendon (avoids radial artery running medially) to radial styloid according to A. K. Henry (Fig. 1).