Lymph Node Flap Based on the Right Transverse Cervical Artery as a Donor Site for Lymph Node Transfer

Abstract Background Vascularized lymph node transfer (VLNT) is one of the surgical options in the treatment of lymphedema, but its mechanism of action has not yet been firmly clarified. In the VLNT mouse models described so far, the lymph node flap is performed between two different sites in the same lymphedematous paw. In this study, we describe an optimized VLNT mouse model using the contralateral paw as donor site, thus removing the bias of transferring a lymph node already damaged by irradiation and/or surgery required to induce lymphedema. Methods A lymphedema was induced on the left posterior paw in four experimental groups of mice (n = 8). Two weeks later, group 1 was the sham one, group 2 underwent a VLNT from the right inguinal region to the left, in group 3 a vascular endothelial growth factor (VEGF)-C sponge was placed alone in the left inguinal region, and in group 4 a VEGF-C sponge was associated to the VLNT. The 32 mice were followed during 3 months. Outcomes included paws volume, skin quality, inflammation in the lymphedematous tissue, and lymphatic network density and function. Results Group 4 displayed significantly higher (p < 0.05) lymphedema regression compared with the other three groups. Conclusions This optimized mouse model of VLNT shows to be handy and effective. It could be exploited to perform further experimental studies about the influence of VLNT on lymphedema. Moreover, the local association between VLNT and biological compounds in this model allows it to be a good preclinical model to identify new potential drugs in lymphedema.

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

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000001202 ◽

2015 ◽

Vol 135 (5) ◽

pp. 939e-940e ◽

Cited By ~ 13

Author(s):

Marga F. Massey ◽

Dhanesh K. Gupta

Keyword(s):

Lymph Node ◽

Donor Site ◽

Donor Site Morbidity ◽

Cervical Artery ◽

Transverse Cervical Artery

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Donor-Site Lymphatic Function after Microvascular Lymph Node Transfer

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e31826d1682 ◽

2012 ◽

Vol 130 (6) ◽

pp. 1246-1253 ◽

Cited By ~ 81

Author(s):

Tiina P. Viitanen ◽

Maija T. Mäki ◽

Marko P. Seppänen ◽

Erkki A. Suominen ◽

Anne M. Saaristo

Keyword(s):

Lymph Node ◽

Donor Site ◽

Lymphatic Function ◽

Lymph Node Transfer

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Omental Vascularized Lymph Node Flap: A Radiographic Analysis

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1642637 ◽

2018 ◽

Vol 34 (07) ◽

pp. 472-477 ◽

Cited By ~ 5

Author(s):

Sarah Sasor ◽

Sunil Tholpady ◽

Michael Chu ◽

Julia Cook

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Donor Site ◽

Gaussian Mixture ◽

Omental Flap ◽

Node Number ◽

Lymph Node Size ◽

Lymph Node Transfer ◽

Node Size ◽

Vascularized Lymph Node Transfer

Background Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest. Methods Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA. Results In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups. Conclusion The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap.

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