Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema.
BACKGROUND
Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.


METHODS
Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).


RESULTS
The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P < 0.05). No episode of infection was noted postoperatively.


CONCLUSIONS
Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|Department of Biological Science and Technology, China Medical University, Taichung, Taiwan.
Pedro
http://orcid.org/0000-0003-4646-2676
P
Ciudad
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
Oscar J
OJ
Manrique
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Shivprasad
http://orcid.org/0000-0003-0337-8677
S
Date
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Mouchammed
M
Agko
Institute of Biotechnology, National Chung Hsing University, Taichung, Taiwan, Republic of China.
John Jaime
JJ
Perez Coca
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Wei-Ling
WL
Chang
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Federico
F
Lo Torto
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Fabio
F
Nicoli
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Michelle
M
Maruccia
Hand and Microsurgery Clinic, Hospital Ángeles del Pedregal Ciudad de México, México.
Javier
J
López Mendoza
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Hung-Chi
HC
Chen
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D024405:Gastroepiploic Artery / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D035002:Lower Extremity / Q000601:surgery; D008198:Lymph Nodes / Q000601:surgery / Q000637:transplantation*; D008209:Lymphedema / Q000175:diagnosis / Q000601:surgery*; D061305:Lymphoscintigraphy / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome