Arch Hand Microsurg.  2021 Jun;26(2):100-108. 10.12790/ahm.20.0071.

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

• Yi CR
• Park MS
• Seo Hj
• Bae SH
• Yoon JA
• Bae YC
• Kim JH

• KMID: 2516154
• DOI: http://doi.org/10.12790/ahm.20.0071

Abstract

Purpose
The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.
Methods
Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.
Results
All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).
Conclusion
The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.

Keyword

Vascularized lymph node transfer; Lymphedema; Upper extremity; Lymphatic flow

Figure

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  Fig. 1. Intraoperative finding of vascularized lymph node transfer in forearm. (A) Subcutaneous fat tissue was resected to secure space for the lymph node and radial vessels were identified. The amount of adipose tissue resected (B) should approximate to the volume of lymph node (C). (D) After inset, the tension-free repair was performed paying attention to compression of the lymph node.

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  Fig. 2. Illustration of mid-forearm after insetting the supraclavicular lymph node flaps. The transverse cervical artery of the lymph node was anastomosed to the radial artery and the transverse cervical vein was anastomosed to the venae comitantes of the radial artery.

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  Fig. 3. Preoperative (A) and 12 month-postoperative (B) finding of the patient 2.

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  Fig. 4. Preoperative (A) and 12 month-postoperative (B) indocyanine green lymphangiography of the patient 2.

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  Fig. 5. Change in the volume of the affected lymphedematous upper extremities at each postoperative follow-up period. Box-whisker plots show the mean (dot), median (horizontal line), interquartile range (box), and range (whiskers).

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