Vascularized Lymph Node Transfer for the Treatment of Posttraumatic Lower Extremity Lymphedema: A Preliminary Report

Author:

Ciudad Pedro12,Huayllani Maria T.3,Forte Antonio J.3ORCID,Boczar Daniel3,Avila Francisco R.3,Escandón Joseph M.4ORCID,Manrique Oscar J.4,Chen Hung-Chi2

Affiliation:

1. Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru

2. Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

3. Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States

4. Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, United States

Abstract

Abstract Background Posttraumatic lymphedema develops more frequently than expected and reports on its management are scarce in the literature. We aimed to report the clinical outcomes of a case series of posttraumatic lymphedema patients treated with different vascularized lymph node transfers (VLNTs). Patients and Methods Five patients with secondary posttraumatic lower limb lymphedema treated with VLNT were included in this report. The groin-VLNT (n = 1), supraclavicular-VLNT (n = 2), and gastroepiploic-VLNT (n = 2) were implemented. The average flap area was 69.8 cm2. Patients underwent postoperative complex decompressive therapy for an average of 10.0 months. Results The average mean circumference reduction rate was 24.4% (range, 10.2–37.6%). Postsurgical reduction in the number of infection episodes per year was observed in all patients. The mean follow-up was 34.2 months. Conclusions VLNT is a promising surgical treatment for posttraumatic lymphedema patients. In our report, VLNT has demonstrated to reduce the volume and number of infections per year in posttraumatic lymphedema.

Funder

Mayo Clinic Center for Individualized Medicine and the Plastic Surgery Foundation

Publisher

Georg Thieme Verlag KG

Subject

Surgery

Reference19 articles.

1. The pathomechanism of posttraumatic edema of lower limbs: I. The effect of extravasated blood, bone marrow cells, and bacterial colonization on tissues, lymphatics, and lymph nodes;G Szczesny;J Trauma,2002

2. Changes in the local blood and lymph microcirculation in response to direct mechanical trauma applied to leg: in vivo study in an animal model;G Szczesny;J Trauma,2001

3. The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: technique and outcomes;P Ciudad;Microsurgery,2017

4. Surgical management of lower extremity lymphedema: A comprehensive review;P Ciudad;Indian J Plast Surg,2019

5. Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer;P Ciudad;Microsurgery,2020

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