The Incidence of Donor-Site Morbidity after Transverse Cervical Artery Vascularized Lymph Node Transfers

AbstractIntroduction:Lymphoedema is a worldwide pandemic causing swelling of tissues due to dysfunctional transport of lymph fluid. Present management concepts are based in conservative palliation of symptoms through manual lymphatic drainage, use of compression garments, manual lymph drainage, exercise, and skin care. Nevertheless, some curative options as autologous lymph node transplantation were shown to reduce lymphoedema in selected cases. Lately, some concern has arisen due to reports of donor site morbidity. A possible solution could be the development of artificial lymph node scaffolds as niches of lymphatic regeneration. Engineering these scaffolds has included cryopreservation of lymph node stroma. However, the effects of cryopreservation on the regeneration capacities of these organs were unknown.Materials and methods:Here, we used the minipig animal model to assess lymphatic regeneration processes after cryopreservation of autologous lymph nodes. Superficial inguinal lymph nodes were excised and conserved at −80°C for 1 month. Thereafter, lymph node fragments were transplanted in the subcutaneous tissue.Results:Regeneration of the lymph nodes was assessed five months after transplantation. We show that lymph node fragment regeneration takes place in spite of former cryopreservation. Transplanted fragments presented typical histological appearance. Their draining capacity was documented by macroscopic transport of Berlin Blue dye as well as through SPECT-CT hybrid imaging.Discussion:In conclusion, our results suggest that processes of cryopreservation can be used in the creation of artificial lymph node scaffolds without major impairment of lymph node fragments regeneration.

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A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience

Journal of Surgical Oncology ◽

10.1002/jso.24349 ◽

2016 ◽

Vol 115 (1) ◽

pp. 37-42 ◽

Cited By ~ 25

Author(s):

Pedro Ciudad ◽

Oscar J. Manrique ◽

Shivprasad Date ◽

Bulent Sacak ◽

Wei-Ling Chang ◽

...

Keyword(s):

Lymph Node ◽

Donor Site ◽

Donor Site Morbidity ◽

Single Center ◽

Single Center Experience ◽

Lymph Node Transfer ◽

Vascularized Lymph Node Transfer

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Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0071 ◽

2021 ◽

Author(s):

Chang Ryul Yi ◽

Min Suk Park ◽

Hyoung-joon Seo ◽

Seong Hwan Bae ◽

Jin A Yoon ◽

...

Keyword(s):

Lymph Node ◽

Upper Extremity ◽

Preliminary Report ◽

Donor Site ◽

Donor Site Morbidity ◽

Symptom Improvement ◽

Supraclavicular Lymph Node ◽

Recipient Site ◽

Lymph Node Transfer ◽

Vascularized Lymph Node Transfer

Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).Conclusion: The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.

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DONOR SITE MORBIDITY AFTER HARVESTING OF BONE FROM ANTERIOR ILIAC CREST FOR MAXILLOFACIAL RECONSTRUCTION

Egyptian Dental Journal ◽

10.21608/edj.2017.74734 ◽

2017 ◽

Vol 63 (1) ◽

pp. 263-269

Author(s):

Ahmed Naguib ◽

Khalid Saad ◽

Rafic Bedir

Keyword(s):

Iliac Crest ◽

Donor Site ◽

Donor Site Morbidity ◽

Maxillofacial Reconstruction

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Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽

10.1177/1558944717744280 ◽

2017 ◽

Vol 13 (6) ◽

pp. 621-626 ◽

Cited By ~ 2

Author(s):

Hyuma A. Leland ◽

Beina Azadgoli ◽

Daniel J. Gould ◽

Mitchel Seruya

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Donor Site ◽

Elbow Flexion ◽

Donor Site Morbidity ◽

Intercostal Nerve ◽

Optimal Number ◽

Musculocutaneous Nerve ◽

Nerve Transfers ◽

Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

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