Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

• Published in: Journal of surgical oncology 2019-03, Vol.119 (4), p.439-448
• Main Authors: Ciudad, Pedro, Manrique, Oscar J, Adabi, Kian, Huang, Tony Chieh‐Ting, Agko, Mouchammed, Trignano, Emilio, Chang, Wei‐Ling, Chen, Tsung‐Wei, Salgado, Christopher J., Chen, Hung‐Chi
• Format: Article
• Language: English
• Subjects: advanced lymphedema; Cancer surgery; Lymphatic system; lymphaticovenous anastomosis; Lymphedema; Quality of life; radical reduction with preservation of perforators; vascularized lymph node transfer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25360

Background Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals. Methods Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed. Results All flaps survived. The mean follow‐up period was 14.2 months (range, 12‐19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7‐fold quality‐of‐life improvement (P