title: Contrast CT-scan for preoperative planning of VSLN (vascularized submental lymph-node) transfer.
abstract: OBJECTIVE
  Vascularized submental lymph-node (VSLN) transfer is gaining popularity as a reliable donor-site in microsurgical treatment of lymphedema. However, variations in number, location, and blood supply to submental lymph-nodes as well as associate skin-paddle make a predictable flap harvest a challenging task. We analyzed this region on preoperative imaging, to improve accuracy of VSLN transfers.
  
  
  METHODS
  Contrast CT-scan analysis of VSLN-flap areas was performed in 58 patients. Number and location of visibly vascularized lymph nodes as well as submental artery perforators were identified, documented, and compared.
  
  
  RESULTS
  About 409 lymph-nodes were found in 50 patients. No significant difference was found in the number of nodes between the right and left side. Significantly more lymph-nodes were found in zones 1B than zones 1A. In eight patients nodes were not identified. In the remaining 50 patients position of the visibly vascularized submental lymph-node was predictable.
  
  
  CONCLUSIONS
  Significantly less lymph-nodes can be found in zone 1a then zone 1b. Location of visibly vascularized lymph nodes can be identified predictably in relation to bony landmarks. Blood supply to 1a nodes and particularly location of dominant skin perforator is unpredictable due to potential crossover. Contrast CT scan can help identify location and blood supply to submental lymph-nodes in most patients. J. Surg. Oncol. 2017;115:23-26. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Damian
authors.initials: D
authors.lastname: Mullan
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Damir
authors.initials: D
authors.lastname: Kosutic
mesh_terms: D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: VSLN; contrast CT-scan; preoperative planning