Surgical Evaluation for Upper Extremity Lymphedema (BioBridge)

To investigate whether the addition of Fibralign's BioBridge® Collagen Matrix (BioBridge) devices to the standard surgery for vascularized lymph node transfer will improve the outcome of surgical treatment in lymphedema of the upper arm.

Inclusion Criteria:The subject must be a breast cancer survivor, at least 3 years beyond completion of cancer therapy, free of clinical disease, and eligible for surgical intervention. Participants who are not able to safely undergo general anesthesia and/or perioperative care for VLNT are excluded.Ages 18 to 75 years (inclusive)Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 2Life expectancy > 2 yearsAcquired (secondary) upper limb lymphedema secondary to breast cancer treatmentThe participant must be eligible for surgical interventionSwelling of 1 limb that is not completely reversed by elevation or compressionStage I-II lymphedema at screening, based on the International Society of Lymphology (ISL) staging systemParticipants must have no evidence of disease (NED), have completed breast cancer therapy 3 years prior to enrollment; use of endocrine therapy is allowed.Completion of a full course of complete decongestive therapy (CDT), according to ISL guidelines at least 12 weeks prior to screening, including use of compression garments for at least 12 weeks without change in regimenWillingness to comply with recommended regimen of self care, with consistent use of compression garments from screening through the entire study duration (through the safety follow up visit), excluding the first 3 weeks postoperatively where patients are required to not wear compression. Self bandaging, use of nighttime compression garments, and intermittent pneumatic compression devices are allowed, but the procedures and regimens are expected to remain consistent from screening though the entire study duration.Consistent use of an appropriately sized compression garment for daytime use.Limb volume (LV) in the affected limb and unaffected limb must be at least 10% of each other.Evidence of abnormal bioimpedance ratio, if feasible, based upon unilateral disease: L Dex > 10 units.Willingness and ability to comply with all study procedures, including measurement of skin biopsy, and preoperative and postoperative imaging studies.Willingness and ability to understand, and to sign a written informed consent form documentExclusion Criteria:Edema arising from increased capillary filtration will be excluded (venous incompetence).Inability to safely undergo general anesthesia and/or perioperative care related to vascularized lymph node transferConcurrent participation in a clinical trial of any other investigational drug or therapy, regardless of indication, within 1 month before screening or 5 times the drug's half life, whichever is longerRecent initiation (≤ 12 weeks) of CDPT for lymphedemaOther medical condition that could lead to acute limb edema, such as (but not limited to) acute venous thrombosis or heart failureOther medical condition that could result in symptoms overlapping those of lymphedema in the affected limb (eg, pain, swelling, decreased range of motion)History of clotting disorder (hypercoagulable state)Chronic (persistent) infection in the affected limbInfection of the lymphedema limb within 1 month prior to screeningCurrently receiving chemotherapy or radiation therapyCurrent evidence, or a history of malignancy within the past 3 years (except for non melanoma skin cancer or cervical cancer in situ treated with curative intent). If the participant has undergone cancer treatment, this must have been completed > 3 years prior to enrollment.Significant or chronic renal insufficiency (defined as serum creatinine > 2.5 mg/dL or an estimated glomerular filtration rate [eGFR] < 30 mL/min at screening) or requires dialytic supportHepatic dysfunction, defined as alanine transaminase (ALT) or aspartate transaminase (AST) levels > 3 × upper limit of the normal range (ULN) and/or bilirubin level > 2 × ULN at screeningAbsolute neutrophil count < 1500 mm3 at screeningHemoglobin concentration < 9 g/dL at screeningBody Mass Index (BMI) >35Known sensitivity to porcine productsAnaphylaxis to iodinePregnancy or nursingSubstance abuse (such as alcohol or drug abuse) within 6 months prior to screeningAny reason (in addition to those listed above) that, in the opinion of the investigator, precludes full participation in the study.