J Breast Cancer.  2016 Mar;19(1):92-95. 10.4048/jbc.2016.19.1.92.

Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection

• Cook KH
• Park MC
• Lee IJ
• Lim SY
• Jung YS

• KMID: 2176327
• DOI: http://doi.org/10.4048/jbc.2016.19.1.92

Abstract

Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.

Keyword

Breast neoplasms; Lipectomy; Lymphedema; Mastectomy; Vascularized composite allotransplantation

MeSH Terms

Breast Neoplasms
Edema
Fibrosis
Humans
Lipectomy
Lymph Node Excision*
Lymph Nodes*
Lymphedema*
Mastectomy
Skin
Toes
Ulcer
Upper Extremity
Vascularized Composite Allotransplantation

Figure

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  Figure 1 Preoperative evaluation and postoperative 1-year evaluation. (A) Preoperative status before vascularized lymph node transfer. (B) Postoperative 1-year evaluation.

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  Figure 2 Lymphoscintigraphy evaluation. (A) Preoperative evaluation which seen in dermal back flow of right forearm. (B) Postoperative 1-year image shows increased lymphatic uptake in wrist area and reduced dermal back flow.

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  Figure 3 Flap elevation and anastomosis. (A) Preoperative surgical design on donor site of right cervical area. (B) Recipient design on right forearm area. (C) Anastomosis procedure of transverse cervical artery based lymph node flap. (D) Immediate postoperative state.

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