title: The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes.
abstract: BACKGROUND
  Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema.
  
  
  METHODS
  From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II-III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and Lymphedema Quality of Life (LYMQOL) questionnaire. Clinical and CT evaluation of donor-site morbidity were performed.
  
  
  RESULTS
  The flap survival rate was 100%, with a mean harvest time of 32 minutes and total operating time of 164 minutes. One case required regrafting for skin graft loss. The mean limb reduction rate was 39.5% at a mean follow-up of 14.7 months. Perioperative lymphoscintigraphy demonstrated transferred lymph node viability and lymphatic transport improvement. LYMQOL showed a 2.6-fold quality-of-life improvement (P < 0.01). No donor-site morbidity was encountered.
  
  
  CONCLUSIONS
  The use of the laparoscopically harvested right gastroepiploic lymph node flap may be a safe technique that improves limb measurements and quality of life in extremity lymphedema patients. © 2015 Wiley Periodicals, Inc. Microsurgery 37:197-205, 2017.
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|Tissue Engineering and Regenerative Medicine Program, Department of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ciudad
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|Department of Plastic, Reconstructive, and Aesthetic Surgery, "Sapienza" University, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Maruccia
authors.affiliation: Department of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Juan
authors.initials: J
authors.lastname: Socas
authors.affiliation: Department of General Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Institute of Healthcare Policy and Management, Department of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Constantinescu
authors.affiliation: Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Kidakorn
authors.initials: K
authors.lastname: Kiranantawat
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Sapountzis
authors.forename: Matthew Sze-Wei
authors.initials: MS
authors.lastname: Yeo
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D024405:Gastroepiploic Artery / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D035002:Lower Extremity / Q000503:physiopathology / Q000601:surgery; D008198:Lymph Nodes / Q000601:surgery / Q000637:transplantation*; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000601:surgery*; D061305:Lymphoscintigraphy / Q000379:methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D034941:Upper Extremity / Q000503:physiopathology / Q000601:surgery