title: Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema.
abstract: BACKGROUND
  Vascularized lymph node transfer has become a popular surgical option to improve lower extremity lymphedema (LEL), although potential donor sites are limited. The free supraclavicular flap with deep cervical lymph nodes has been recently associated with a minimal risk of secondary lymphedema caused by donor site dissection. However, the effectiveness of this procedure has not yet been evaluated.
  
  
  METHODS
  Vascularized supraclavicular lymph node transfer (VSLNT) was performed for patients with International Society of Lymphology late stage II or more severe LEL. The results were compared with lymphaticovenular anastomosis (LVA) performed for patients with the same stages of severity. To evaluate improvement in lymphatic function, indocyanine green lymphography and lymphoscintigraphy were performed.
  
  
  RESULTS
  Vascularized supraclavicular lymph node transfer was performed in 13 limbs of 13 patients. The results were compared with 43 limbs of 33 patients who underwent multiple LVA. No severe complications were observed in either group. Improvement in lymphatic function, as measured by the LEL index, was 26.5 ± 4.4 and 21.2 ± 2.0 in the VSLNT and LVA groups, respectively. Lymphatic function was improved in 7 cases in the VSLNT group and 10 cases in the LVA group.
  
  
  CONCLUSIONS
  Vascularized supraclavicular lymph node transfer is an effective technique for the treatment of advanced stage LEL. Lymphaticovenular anastomosis is also effective, but to a lesser degree than VSLNT. However, LVA is less invasive and requires a shorter hospital stay.
authors: From the *Department of Plastic and Reconstructive Surgery, Chiba Cancer Center; †Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba; ‡Department of Plastic and Reconstructive Surgery in Kochi Medical School Hospital, Nankoku; and §Division of Nuclear Medicine, Chiba Cancer Center, Chiba, Japan.
authors: Shinsuke
authors: S
authors: Akita
authors: Nobuyuki
authors: N
authors: Mitsukawa
authors: Motone
authors: M
authors: Kuriyama
authors: Yoshitaka
authors: Y
authors: Kubota
authors: Masakazu
authors: M
authors: Hasegawa
authors: Hideki
authors: H
authors: Tokumoto
authors: Tatsuya
authors: T
authors: Ishigaki
authors: Takashi
authors: T
authors: Togawa
authors: Junpei
authors: J
authors: Kuyama
authors: Kaneshige
authors: K
authors: Satoh
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008198:Lymph Nodes / Q000098:blood supply / Q000637:transplantation*; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*