Introduction: Lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established lymphedema treatments. However, LVA is only effective for early disease and VLNT can cause donor-site lymphedema and contour deformity. Vascularized lymph vessel transfer (VLVT) is free of these limitations. We described our experience of a new VLVT technique.
Patients and Methods: Patients with fluid-predominant lymphedema who failed lymphedema therapy were offered surgical intervention. Those with early injury seen on indocyanine green (ICG) lymphography were treated with LVA. Superficial iliac artery perforator (SCIP)-based lymph vessel transfer was offered to those with advanced injury. After lymphographic mapping of the lymph vessels and doppler perforator mapping, thin SCIP flap was harvested. Only the superficial fat layer was included to recruit the lymph vessels while preserving the lymph nodes. The flaps were vascularized with end-to-side or perforator-to-perforator anastomosis.
Results: The SCIP-based lymph vessel flap was performed in 6 patients with extremity lymphedema. Four had upper and 2 had lower extremity disease. One had partial (< 5%) flap loss which was managed with local wound care. All others had uneventful postoperative course. Follow-up was 13-27 months. All experienced prompt relief of symptoms and circumference reduction. At 1 year out, all demonstrated durable symptomatic improvement with correlating improvement on ICG lymphography. Three of 6 patients achieved minimal compression garment use. None developed donor site lymphedema.
Conclusions: Our early experience of the SCIP-based VLVT showed promising result in treating extremity lymphedema and suggested it as a viable alternative treatment to LVA and VLNT.
Wei F. Chen, Maria McNurlen, Johnson Ding, Mindy Bowen. Vascularized Lymph Vessel Transfer for Extremity Lymphedema - Is Transfer of Lymph Node Still Necessary? International Microsurgery Journal. 2019;3(3):1. DOI: 10.24983/scitemed.imj.2019.00119