title: Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
abstract: BACKGROUND
  The free vascularized omental lymphatic flap provides an option without the risk for iatrogenic donor site lymphedema that plagues alternative lymph node transfer donor sites. The omental flap has been associated with significant morbidity in the past; however, with modern techniques and advanced in technology, a minimally invasive approach to flap harvest is feasible. We present the long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
  
  
  METHODS
  All consecutive patients with advanced lymphedema undergoing minimally invasive free vascularized omental lymphatic flap transfer were included. Perioperative evaluation included qualitative assessments, lymphoscintigraphy, and volumetric measurements.
  
  
  RESULTS
  Overall, 42 patients underwent a free omental lymphatic flap and had a mean follow-up of 14 (3-32) months. Subjective improvements were noted in 83% of patients. Mean volumetric improvement was 22%. Complications occurred in 16% (n = 7) of patients; this included one episode of pancreatitis and one flap loss. Postoperative imaging revealed viable lymphatic transfers. Cellulitis history was present in 74% (n = 31) patients with post-operative cellulitis occurring in 5% (n = 2) patients.
  
  
  CONCLUSIONS
  The minimally invasive free vascularized omental lymphatic flap provides a safe donor site, a durable and versatile flap, and an efficacious therapy against lymphedema and lymphedema-related cellulitis. J. Surg. Oncol. 2017;115:84-89. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.affiliation: Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.affiliation: Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas.
authors.forename: Veda A
authors.initials: VA
authors.lastname: Womack
authors.affiliation: Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Franklin C
authors.initials: FC
authors.lastname: Wong
authors.affiliation: Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009852:Omentum / Q000098:blood supply / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: LVA; LVB; VLNT; lymphatic surgery; lymphedema; lymphovenous anastomosis; lymphovenous bypass; vascularized lymph node transfer