Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema

• Published in: Microsurgery 2017-10, Vol.37 (7), p.771-779
• Main Authors: Ciudad, Pedro, Manrique, Oscar J., Date, Shivprasad, Agko, Mouchammed, Perez Coca, John Jaime, Chang, Wei‐Ling, Lo Torto, Federico, Nicoli, Fabio, Maruccia, Michelle, López Mendoza, Javier, Chen, Hung‐Chi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ankle; Breast cancer; Cancer; Division; Elbow; Elbow (anatomy); Female; Follow-Up Studies; Free Tissue Flaps - blood supply; Free Tissue Flaps - transplantation; Gastroepiploic Artery - surgery; Gastroepiploic Artery - transplantation; Humans; Knee; Laparoscopy; Laparoscopy - methods; Lower Extremity - surgery; Lymph; Lymph nodes; Lymph Nodes - surgery; Lymph Nodes - transplantation; Lymphatic drainage; Lymphatic system; Lymphedema; Lymphedema - diagnosis; Lymphedema - surgery; Lymphoscintigraphy - methods; Microsurgery; Middle Aged; Morbidity; Patients; Preoperative Care - methods; Quality of Life; Recovery of Function - physiology; Risk Assessment; Sampling Studies; Severity of Illness Index; Tissue and Organ Harvesting - methods; Treatment Outcome; Wrist
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30168

Background Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset. Patients and Methods Between 2014 and 2015, four‐patients with upper limb breast cancer‐related lymphedema and three‐patients with lower limb pelvic cancer‐related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42–65 years). Results The average flap size after division was 6.3 cm in length (range, 5–7 cm) and 3.4 cm in width (range, 3–4 cm). The mean pedicle length was 3.2 cm (range, 2.5–4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow‐up of 9.7 months (range, 8–11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P