Download PDF
Semin Plast Surg 2018; 32(01): 028-035
DOI: 10.1055/s-0038-1632401
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vascularized Lymph Node Transfer for Lymphedema

Mark V. Schaverien
1   Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
,
Ido Badash
2   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Ketan M. Patel
3   Division of Plastic and Reconstructive Surgery, Keck Medical Center of USC, University of Southern California, Los Angeles, California
,
Jesse C. Selber
1   Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
,
Ming-Huei Cheng
4   Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
› Author Affiliations
Further Information

Publication History

Publication Date:
09 April 2018 (online)

   Permissions and Reprints

Abstract

Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.

Keywords

lymphedema - vascularized lymph node transfer - flap - groin - supraclavicular - submental - gastroepiploic - mesenteric
 

  • References

  • 1 Chang DW, Masia J, Garza III R, Skoracki R, Neligan PC. Lymphedema: Surgical and Medical Therapy. Plast Reconstr Surg 2016; 138 (3, Suppl): 209S-218S
    CrossrefPubMedGoogle Scholar
  • 2 Gratzon A, Schultz J, Secrest K, Lee K, Feiner J, Klein RD. Clinical and psychosocial outcomes of vascularized lymph node transfer for the treatment of upper extremity lymphedema after breast cancer therapy. Ann Surg Oncol 2017; 24 (06) 1475-1481
    CrossrefPubMedGoogle Scholar
  • 3 Dionyssiou D, Demiri E, Tsimponis A. , et al. A randomized control study of treating secondary stage II breast cancer-related lymphoedema with free lymph node transfer. Breast Cancer Res Treat 2016; 156 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 4 Shesol BF, Nakashima R, Alavi A, Hamilton RW. Successful lymph node transplantation in rats, with restoration of lymphatic function. Plast Reconstr Surg 1979; 63 (06) 817-823
    CrossrefPubMedGoogle Scholar
  • 5 Chen HC, O'Brien BM, Rogers IW, Pribaz JJ, Eaton CJ. Lymph node transfer for the treatment of obstructive lymphoedema in the canine model. Br J Plast Surg 1990; 43 (05) 578-586
    CrossrefPubMedGoogle Scholar
  • 6 Patel KM, Lin CY, Cheng MH. From theory to evidence: long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers. J Reconstr Microsurg 2015; 31 (01) 26-30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Suami H, Scaglioni MF, Dixon KA, Tailor RC. Interaction between vascularized lymph node transfer and recipient lymphatics after lymph node dissection-a pilot study in a canine model. J Surg Res 2016; 204 (02) 418-427
    CrossrefPubMedGoogle Scholar
  • 8 Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. Proposed pathway and mechanism of vascularized lymph node flaps. Gynecol Oncol 2016; 141 (01) 182-188
    PubMedGoogle Scholar
  • 9 Cheng MH, Huang JJ, Wu CW. , et al. The mechanism of vascularized lymph node transfer for lymphedema: natural lymphaticovenous drainage. Plast Reconstr Surg 2014; 133 (02) 192e-198e
    CrossrefPubMedGoogle Scholar
  • 10 Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ. Mechanisms of lymphatic regeneration after tissue transfer. PLoS One 2011; 6 (02) e17201
    CrossrefPubMedGoogle Scholar
  • 11 Aschen SZ, Farias-Eisner G, Cuzzone DA. , et al. Lymph node transplantation results in spontaneous lymphatic reconnection and restoration of lymphatic flow. Plast Reconstr Surg 2014; 133 (02) 301-310
    CrossrefPubMedGoogle Scholar
  • 12 Viitanen TP, Visuri MT, Hartiala P. , et al. Lymphatic vessel function and lymphatic growth factor secretion after microvascular lymph node transfer in lymphedema patients. Plast Reconstr Surg Glob Open 2013; 1 (02) 1-9
    CrossrefPubMedGoogle Scholar
  • 13 Hara H, Mihara M, Seki Y, Todokoro T, Iida T, Koshima I. Comparison of indocyanine green lymphographic findings with the conditions of collecting lymphatic vessels of limbs in patients with lymphedema. Plast Reconstr Surg 2013; 132 (06) 1612-1618
    CrossrefPubMedGoogle Scholar
  • 14 Huang JJ, Gardenier JC, Hespe GE. , et al. Lymph node transplantation decreases swelling and restores immune responses in a transgenic model of lymphedema. PLoS One 2016; 11 (12) e0168259
    CrossrefPubMedGoogle Scholar
  • 15 Granzow JW, Soderberg JM, Dauphine C. A novel two-stage surgical approach to treat chronic lymphedema. Breast J 2014; 20 (04) 420-422
    CrossrefPubMedGoogle Scholar
  • 16 Nicoli F, Constantinides J, Ciudad P. , et al. Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema. Lasers Med Sci 2015; 30 (04) 1377-1385
    CrossrefPubMedGoogle Scholar
  • 17 Campisi CC, Ryan M, Boccardo F, Campisi C. Fibro-lipo-lymph-aspiration with a lymph vessel sparing procedure to treat advanced lymphedema after multiple lymphatic-venous anastomoses: the complete treatment protocol. Ann Plast Surg 2017; 78 (02) 184-190
    CrossrefPubMedGoogle Scholar
  • 18 Clodius L, Smith PJ, Bruna J, Serafin D. The lymphatics of the groin flap. Ann Plast Surg 1982; 9 (06) 447-458
    CrossrefPubMedGoogle Scholar
  • 19 Tobbia D, Semple J, Baker A, Dumont D, Johnston M. Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema. Plast Reconstr Surg 2009; 124 (03) 777-786
    CrossrefPubMedGoogle Scholar
  • 20 Scaglioni MF, Arvanitakis M, Chen Y-C, Giovanoli P, Chia-Shen Yang J, Chang EI. Comprehensive review of vascularized lymph node transfers for lymphedema: outcomes and complications. Microsurgery 2016
    PubMedGoogle Scholar
  • 21 Scaglioni MF, Suami H. Lymphatic anatomy of the inguinal region in aid of vascularized lymph node flap harvesting. J Plast Reconstr Aesthet Surg 2015; 68 (03) 419-427
    CrossrefPubMedGoogle Scholar
  • 22 Becker C. Microsurgical procedures: vascularized lymph node transfer from the groin. Principles and Practice of Lymphedema Surgery. Philadelphia, PA: Elsevier; 2016: 122-132
    Google Scholar
  • 23 Patel KM, Chu SY, Huang JJ, Wu CW, Lin CY, Cheng MH. Preplanning vascularized lymph node transfer with duplex ultrasonography: an evaluation of 3 donor sites. Plast Reconstr Surg Glob Open 2014; 2 (08) e193
    CrossrefPubMedGoogle Scholar
  • 24 Dayan JH, Dayan E, Kagen A. , et al. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study. J Reconstr Microsurg 2014; 30 (01) 41-45
    PubMedGoogle Scholar
  • 25 Raju A, Chang DW. Vascularized lymph node transfer for treatment of lymphedema: a comprehensive literature review. Ann Surg 2015; 261 (05) 1013-1023
    CrossrefPubMedGoogle Scholar
  • 26 Vignes S, Blanchard M, Yannoutsos A, Arrault M. Complications of autologous lymph-node transplantation for limb lymphoedema. Eur J Vasc Endovasc Surg 2013; 45 (05) 516-520
    CrossrefPubMedGoogle Scholar
  • 27 Dayan JH, Dayan E, Smith ML. Reverse lymphatic mapping: a new technique for maximizing safety in vascularized lymph node transfer. Plast Reconstr Surg 2015; 135 (01) 277-285
    CrossrefPubMedGoogle Scholar
  • 28 Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg 2013; 131 (06) 1286-1298
    CrossrefPubMedGoogle Scholar
  • 29 Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 2006; 243 (03) 313-315
    CrossrefPubMedGoogle Scholar
  • 30 Lin CH, Ali R, Chen SC. , et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg 2009; 123 (04) 1265-1275
    CrossrefPubMedGoogle Scholar
  • 31 Telang P, Jagannathan M, Devale M. A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects. Indian J Plast Surg 2009; 42 (01) 4-12
    CrossrefPubMedGoogle Scholar
  • 32 Kazanjian VH, Converse JM. Surgical Treatment of Facial Injuries. 3rd ed. Baltimore; Williams & Wilkins; 1974
    Google Scholar
  • 33 Pallua N, Machens HG, Rennekampff O, Becker M, Berger A. The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99 (07) 1878-1884 , discussion 1885–1886
    CrossrefPubMedGoogle Scholar
  • 34 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000; 105 (03) 842-851 , discussion 852–854
    CrossrefPubMedGoogle Scholar
  • 35 Bank J, Chang DW. Microsurgical procedures: vascularized lymph node transfer from the supraclavicular region. Principles and Practice of Lymphedema Surgery. Philadelphia, PA: Elsevier; 2016: 148-154
    Google Scholar
  • 36 Mardonado AA, Chen R, Chang DW. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema: A prospective study of 100 consecutive cases. J Surg Oncol 2017; 115 (01) 68-71
    CrossrefPubMedGoogle Scholar
  • 37 Lee M, McClure E, Reinertsen E, Granzow JW. Lymphedema of the upper extremity following supraclavicular lymph node harvest. Plast Reconstr Surg 2015; 135 (06) 1079e-1082e
    CrossrefPubMedGoogle Scholar
  • 38 Huang JJ. Lymph node transfer to distal extremity. Lymphedema. Cham: Springer; 2015: 279-288
    Google Scholar
  • 39 Sapountzis S, Singhal D, Rashid A, Ciudad P, Meo D, Chen HC. Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer. Ann Plast Surg 2014; 73 (04) 398-401
    CrossrefPubMedGoogle Scholar
  • 40 Ooi ASH, Chang DW. 5-step harvest of supraclavicular lymph nodes as vascularized free tissue transfer for treatment of lymphedema. J Surg Oncol 2017; 115 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 41 Akita S, Mitsukawa N, Kuriyama M. , et al. Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema. Ann Plast Surg 2015; 74 (05) 573-579
    CrossrefPubMedGoogle Scholar
  • 42 Martin D, Pascal JF, Baudet J. , et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 1993; 92 (05) 867-873
    CrossrefPubMedGoogle Scholar
  • 43 Shi CL, Wang XC. Reconstruction of lower face defect or deformity with submental artery perforator flaps. Ann Plast Surg 2012; 69 (01) 41-44
    CrossrefPubMedGoogle Scholar
  • 44 Cheng MH, Huang JJ, Nguyen DH. , et al. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Gynecol Oncol 2012; 126 (01) 93-98
    CrossrefPubMedGoogle Scholar
  • 45 Cheng MH, Patel KM. Microsurgical procedures: vascularized lymph node transfer from the submental region. Principles and Practice of Lymphedema Surgery. Philadelphia, PA: Elsevier; 2016: 138-147
    Google Scholar
  • 46 Steinbacher J, Tinhofer IE, Meng S. , et al. The surgical anatomy of the supraclavicular lymph node flap: a basis for the free vascularized lymph node transfer. J Surg Oncol 2017; 115 (01) 60-62
    CrossrefPubMedGoogle Scholar
  • 47 Batra APS, Mahajan A, Gupta K. Marginal mandibular branch of the facial nerve: an anatomical study. Indian J Plast Surg 2010; 43 (01) 60-64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Patel KM, Lin CY, Cheng MH. A prospective evaluation of lymphedema-specific quality-of-life outcomes following vascularized lymph node transfer. Ann Surg Oncol 2015; 22 (07) 2424-2430
    CrossrefPubMedGoogle Scholar
  • 49 Suami H, O'Neill JK, Pan WR, Taylor GI. Superficial lymphatic system of the upper torso: preliminary radiographic results in human cadavers. Plast Reconstr Surg 2008; 121 (04) 1231-1239
    CrossrefPubMedGoogle Scholar
  • 50 Smith ML, Molina BJ, Dayan E. , et al. Heterotopic vascularized lymph node transfer to the medial calf without a skin paddle for restoration of lymphatic function: proof of concept. J Surg Oncol 2017; 115 (01) 90-95
    CrossrefPubMedGoogle Scholar
  • 51 Barreiro GC, Baptista RR, Kasai KE. , et al. Lymph fasciocutaneous lateral thoracic artery flap: anatomical study and clinical use. J Reconstr Microsurg 2014; 30 (06) 389-396
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Bhattacharya S, Bhagia SP, Bhatnagar SP, Aabdi SM, Chandra R. The anatomical basis of the lateral thoracic flap. Eur J Plast Surg 1990; 13: 238-240
    CrossrefPubMedGoogle Scholar
  • 53 Harii K, Torii S, Sekiguchi J. The free lateral thoracic flap. Plast Reconstr Surg 1978; 62 (02) 212-222
    CrossrefPubMedGoogle Scholar
  • 54 Tinhofer IE, Meng S, Steinbacher J. , et al. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study. J Surg Oncol 2017
    PubMedGoogle Scholar
  • 55 Clough KB, Nasr R, Nos C, Vieira M, Inguenault C, Poulet B. New anatomical classification of the axilla with implications for sentinel node biopsy. Br J Surg 2010; 97 (11) 1659-1665
    CrossrefPubMedGoogle Scholar
  • 56 Goldsmith HS, De los Santos R. Omental transposition in primary lymphedema. Surg Gynecol Obstet 1967; 125 (03) 607-610
    PubMedGoogle Scholar
  • 57 Ciudad P, Maruccia M, Socas J. , et al. The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: technique and outcomes. Microsurgery 2017; 37 (03) 197-205
    CrossrefPubMedGoogle Scholar
  • 58 Agko M, Ciudad P, Chen HC. Histo-anatomical basis of the gastroepiploic vascularized lymph node flap: the overlooked “micro” lymph nodes. J Plast Reconstr Aesthet Surg 2018; 71 (01) 118-120
    CrossrefPubMedGoogle Scholar
  • 59 Suma H. Gastroepiploic artery graft in coronary artery bypass grafting. Ann Cardiothorac Surg 2013; 2 (04) 493-498
    PubMedGoogle Scholar
  • 60 Suma H, Tanabe H, Takahashi A. , et al. Twenty years experience with the gastroepiploic artery graft for CABG. Circulation 2007; 116 (11, Suppl) I188-I191
    CrossrefPubMedGoogle Scholar
  • 61 Saltz R, Stowers R, Smith M, Gadacz TR. Laparoscopically harvested omental free flap to cover a large soft tissue defect. Ann Surg 1993; 217 (05) 542-546 , discussion 546–547
    CrossrefPubMedGoogle Scholar
  • 62 Zaha H, Inamine S. Laparoscopically harvested omental flap: results for 96 patients. Surg Endosc 2010; 24 (01) 103-107
    CrossrefPubMedGoogle Scholar
  • 63 van Garderen JA, Wiggers T, van Geel AN. Complications of the pedicled omentoplasty. Neth J Surg 1991; 43 (05) 171-174
    PubMedGoogle Scholar
  • 64 Ciudad P, Manrique OJ, Date S. , et al. Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. Microsurgery 2017; 37 (07) 771-779
    CrossrefPubMedGoogle Scholar
  • 65 Ciudad P, Date S, Lee MH. , et al. Robotic harvest of a right gastroepiploic lymph node flap. Arch Plast Surg 2016; 43 (02) 210-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 66 Kinmonth JB, Hurst PA, Edwards JM, Rutt DL. Relief of lymph obstruction by use of a bridge of mesentery and ileum. Br J Surg 1978; 65 (12) 829-833
    CrossrefPubMedGoogle Scholar
  • 67 Hurst PA, Stewart G, Kinmonth JB, Browse NL. Long term results of the enteromesenteric bridge operation in the treatment of primary lymphoedema. Br J Surg 1985; 72 (04) 272-274
    CrossrefPubMedGoogle Scholar
  • 68 Coriddi M, Skoracki R, Eiferman D. Vascularized jejunal mesenteric lymph node transfer for treatment of extremity lymphedema. Microsurgery 2017; 37 (02) 177-178
    CrossrefPubMedGoogle Scholar
  • 69 Schaverien MV, Hofstetter WL, Selber JC. Vascularized jejunal mesenteric lymph node transfer for lymphedema: a novel approach. Plast Reconstr Surg 2017
    PubMedGoogle Scholar
  • 70 Coriddi M, Wee C, Meyerson J, Eiferman D, Skoracki R. Vascularized jejunal mesenteric lymph node transfer: a novel surgical treatment for extremity lymphedema. J Am Coll Surg 2017; 225 (05) 650-657
    CrossrefPubMedGoogle Scholar
  • 71 Ciudad P, Agko M, Perez Coca JJ. , et al. Comparison of long-term clinical outcomes among different vascularized lymph node transfers: 6-year experience of a single center's approach to the treatment of lymphedema. J Surg Oncol 2017; 116 (06) 671-682
    CrossrefPubMedGoogle Scholar