title: Heterotopic vascularized lymph node transfer to the medial calf without a skin paddle for restoration of lymphatic function: Proof of concept.
abstract: BACKGROUND
  The use of heterotopic vascularized lymph node transfer (HVLNT) for the treatment of lower extremity lymphedema is still evolving. Current techniques, either place the lymph nodes in the thigh without a skin paddle or at the ankle requiring an unsightly and often bulky skin paddle for closure. We explored the feasibility of doing a below-knee transfer without a skin paddle using the medial sural vessels as recipient vessels and report our experience in 21 patients.
  
  
  METHODS
  A retrospective review of all patients who underwent HVLNT to the medial calf was performed. Postoperative magnetic resonance angiography (MRA) and lymphoscintigraphy (LS) were analyzed to assess lymph node viability and function after transfer.
  
  
  RESULTS
  Twenty-one patients underwent HVLNT to the medial calf. Postoperative imaging was performed at an average of 11 months after surgery. Thirteen patients had postoperative MRA, of whom 12 demonstrated viable lymph nodes. Seven patients underwent postoperative LS, of whom three demonstrated uptake in the transferred nodes. In the other four patients, the injectate failed to reach the level of the proximal calf.
  
  
  CONCLUSIONS
  We provide proof of concept that HVLNT to the lower leg using the medial sural vessels without a skin paddle can result in viable and functional lymph nodes in the setting of lower extremity lymphedema. J. Surg. Oncol. 2017;115:90-95. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Bianca J
authors.initials: BJ
authors.lastname: Molina
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Erez
authors.initials: E
authors.lastname: Dayan
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Saint-Victor
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Julie N
authors.initials: JN
authors.lastname: Kim
authors.affiliation: Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York.
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kahn
authors.affiliation: Department of Radiology, Mount Sinai Beth Israel, New York, New York.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kagen
authors.affiliation: Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Dayan
mesh_terms: D000328:Adult; D000368:Aged; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D007866:Leg / Q000601:surgery; D008198:Lymph Nodes / Q000098:blood supply / Q000502:physiology / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D012189:Retrospective Studies; D016038:Skin Transplantation; D016042:Transplantation, Heterotopic
keywords: heterotopic vascularized lymph node transfer; lymphedema; medial sural