title: Free vascularized lymph node transfer for treatment of lymphedema: A systematic evidence based review.
abstract: BACKGROUND
  Free vascularized lymph node transfer (VLNT) is a relatively novel technique for treatment of lymphedema. The purpose of this systematic review was to evaluate the current evidence on VLNT and to determine if there is objective data concerning improved outcomes.
  
  
  METHODS
  A literature search of PubMed, EMBASE and CENTRAL electronic databases was conducted to identify articles written in the English language on VLNT for treatment of lymphedema. Publications were selected according to inclusion criteria. Papers reporting adjunct techniques and those that did not describe outcomes were excluded. Data including patient demographics, surgical technique, complications and outcomes were extracted. A quality score was calculated for each article.
  
  
  RESULTS
  Eighteen studies were included with an overall study population of 305 patients. Mean quality score of articles was 5.3 with levels of evidence range from II to IV. Among 182 patients who underwent limb circumference assessment, 165 (91%) showed postoperative improvement. Reduction of limb volume was noted in 98 of 114 (86%) patients. Ninety two patients underwent lymphoscintigraphy/lymphangiography and 55 (60%) demonstrated moderate or significant improvement of flow. Patient satisfaction was questioned in 105 patients and with exception of 7 patients, all reported a high satisfaction level with significant relief in symptoms and improved quality of life. Publications also reported a reduction in infectious episodes.
  
  
  CONCLUSIONS
  VLNT appears to provide improvement in lymphedema. More studies with standardized methods for reporting outcomes and uniform patient selection are needed to evaluate this technique thoroughly.
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address: cemile.ozturk@roswellpark.org.
authors.forename: Cemile Nurdan
authors.initials: CN
authors.lastname: Ozturk
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Can
authors.initials: C
authors.lastname: Ozturk
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Glasgow
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Platek
authors.affiliation: Indiana University, School of Medicine, Indianapolis, IN, USA.
authors.forename: Zain
authors.initials: Z
authors.lastname: Ashary
authors.affiliation: State University of New York, Jacob's School of Medicine, Buffalo, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kuhn
authors.affiliation: University at Buffalo Health Sciences Library, Buffalo, NY, USA.
authors.forename: Nell
authors.initials: N
authors.lastname: Aronoff
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lohman
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Raffi
authors.initials: R
authors.lastname: Gurunluoglu
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008198:Lymph Nodes / Q000637:transplantation*; D008209:Lymphedema / Q000175:diagnosis / Q000601:surgery*; D008220:Lymphography; D061305:Lymphoscintigraphy; D008408:Mastectomy / Q000009:adverse effects; D011183:Postoperative Complications
keywords: Lymph node transfer; Lymph node transplantation; Lymphedema; VLNT; Vascularized lymph node transfer