Vascularized Lymph Node Transfer for Lymphedema

AbstractAdvances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.

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Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.03.017 ◽

2020 ◽

Vol 73 (10) ◽

pp. 1897-1916

Author(s):

Aladdin H. Hassanein ◽

Rachel Danforth ◽

Will DeBrock ◽

Brian Mailey ◽

Mary Lester ◽

...

Keyword(s):

Lymph Node ◽

Inferior Epigastric Artery ◽

Safe Option ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Lymph Node Transfer ◽

Vascularized Lymph Node Transfer

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Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1603738 ◽

2017 ◽

Vol 33 (08) ◽

pp. 571-578 ◽

Cited By ~ 4

Author(s):

Hideki Tokumoto ◽

Yoshihisa Yamaji ◽

Yoshitaro Sasahara ◽

Yoshitaka Kubota ◽

Maiko Kubo ◽

...

Keyword(s):

Breast Reconstruction ◽

Compression Therapy ◽

Diep Flap ◽

Advanced Stage ◽

Groin Flap ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Breast Cancer Related Lymphedema ◽

Lymph Node Transfer ◽

Artery Perforator

Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated. Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography. Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group. Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.

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