title: Risk of donor-site lymphatic vessel dysfunction after microvascular lymph node transfer.
abstract: BACKGROUND
  Microvascular lymph node transfer has been used to improve lymphatic function in patients with lymphoedema. We previously reported changes in the lymphatic function of the donor limb after lymph node transfer. For this reason, we modified our surgical method to be more conservative.
  
  
  METHODS
  Microvascular lymph node transfer was performed in 13 patients using the previously reported original method. Sixteen patients were operated upon using the more conservative modified method. Lymphatic function in the donor limb was evaluated using volumetry, lymphoscintigraphy and tissue water percentage.
  
  
  RESULTS
  In the original method group, the donor-limb volume was on average greater (199 ± 540 ml) than in the non-operated control limb. The volume difference between the limbs was smaller (151 ± 463 ml) in the modified method group. Two patients in the original method group had abnormal transport index (Ti) values in lymphoscintigraphy indicating decreased lymphatic function of the donor limb. In the modified method group, the Ti-values remained normal. The tissue water percentage of the donor limb was on average 40% ± 4% in the original method group and 40% ± 3% in the modified method group. Importantly, none of the patients in either group developed clinical lymphoedema in the donor limb during the 11-84-month follow-up.
  
  
  CONCLUSIONS
  Even with the more conservative lymph node transfer method, we can observe slight, subclinical signs of lymphatic dysfunction in the donor limb. These results highlight the importance of minimizing the surgical exploration in the inguinal area and avoiding damage to the lymphatic vessels or sentinel nodes draining the lower limb.
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Sulo
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Hartiala
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Viitanen
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Mäki
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Seppänen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: anne.saarikko@hus.fi.
authors.forename: A
authors.initials: A
authors.lastname: Saarikko
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D005260:Female; D006119:Groin; D006801:Humans; D008198:Lymph Nodes / Q000637:transplantation*; D042601:Lymphatic Vessels / Q000473:pathology / Q000503:physiopathology*; D008209:Lymphedema / Q000601:surgery*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D060053:Transplant Donor Site / Q000473:pathology / Q000503:physiopathology*
keywords: Autologous; Breast reconstruction; Lymphoedema; Reconstructive surgery