The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema (original) (raw)
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Plastic and Reconstructive Surgery - Global Open, 2015
A 59-year-old woman had developed lower limb lymphedema for 4 years post hysterectomy, pelvic lymph node dissection, radiation therapy, and chemotherapy for endometrial cancer. Despite complete decongestive therapy with an elastic stocking for a year, lymphedema gradually progressed and cellulitis in her left lower limb recurred every 3-4 months. She had undergone the Charles procedure of left leg at another hospital 2 years before she was referred to our hospital for further treatment. The circumferential differentiation values on the left lower limb at 15 cm above knee, 15 cm below knee, and 10 cm above ankle were 22.2%, −34.7%, and 77.8%, respectively. Her left lower leg and foot had chronic infection and cellulitis. Lymphoscintigraphy revealed total lymphatic obstruction of the left lower limb (Fig. 1). SURGICAL TECHNIQUE A skin paddle (9 × 2.5 cm) with a vascularized submental lymph node (VSLN) flap was designed on the left side and transferred to her left ankle according to a previously published technique. 1 The left facial artery and vein were anastomosed with posterior tibial artery and vein in end-to-side and end-toend fashions, respectively. The right VSLN flap was harvested in the same fashion and transferred to her left thigh. The right facial artery and vein were anastomosed with the descending branch of lateral cir-Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.
Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient
Plastic and reconstructive surgery. Global open, 2017
The greater omentum is supplied by the right, middle, and left omental arteries, which arise from the right and left gastroepiploic arteries. All or part of the greater omentum can be harvested based on this blood supply for free tissue transfer. It has stimulated new interest in its use as the donor site in the treatment of lymphedema. For patients who have failed other management options or have limited peripheral lymph node donor sites, the greater omental lymph node flap may offer the best chance for lymphedema treatment. We report a 59-year-old woman with a history of left breast cancer who was treated with left modified radical mastectomy and axillary lymph node dissection and developed left upper extremity Grade IV lymphedema. She received vascularized groin lymph node transfer and lymphaticovenous anastomosis, but the result was not satisfactory. She also had nasopharyngeal cancer that was treated with radiotherapy to the head and neck, making use of the submental lymph node...
Gynecologic Oncology, 2012
Objective. Vascularized groin lymph node flaps have been successfully transferred to the wrist to treat postmastecomy upper limb lymphedema. This study investigated the anatomy, mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap transfer for the treatment of lower limb lymphedema. Methods. Bilateral regional submental flaps were dissected from three fresh adult cadavers for histological study. A unilateral submental flap was dissected in another six fresh cadavers after latex injection. The VSLN flap was transferred to the ankles of seven lower extremities in six patients with chronic lower extremity lymphedema. The mean patient age was 61± 9.4 years. The average duration of lymphedema symptoms was 71± 42.2 months. Results. There was a mean of 3.3 ± 1.5 lymph nodes around the submental artery typically at the junction with the facial artery, on the six cadaveric histological sections. Mean of 2.3 ± 0.8 sizable lymph nodes were dissected and supplied by the submental artery in six cadaveric latex-injected submental flaps. All seven VSLN flaps survived. One flap required re-exploration for venous congestion but was successfully salvaged. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumference was 64± 11.5% above the knee, 63.7± 34.3% below the knee and 67.3± 19.2% above the ankle. Conclusion. The transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema.
Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema
Journal of Reconstructive Microsurgery Open
Background Vascularized lymph node transfer is performed for select patients with lymphedema who remain refractory to nonsurgical therapies. Typically, this involves a microvascular free tissue transfer of donor lymph nodes to the affected area. We describe our experience with the transfer of a pedicled adipofascial flap containing the superficial inguinal lymph nodes for lower extremity lymphedema or penoscrotal lymphedema. Methods In eight patients, a unilateral pedicled superficial inguinal lymph node flap was harvested. The flap consisted of subscarpal adipofascial tissue between the level of the inguinal ligament and the groin crease. Blood supply was from either the superficial circumflex iliac vessels or the superficial inferior epigastric vessels. In certain patients, concurrent lymphaticovenular anastomosis was attempted as well. Results Four patients underwent pedicled superficial inguinal lymph node flap transfer for lower extremity lymphedema and for the other four patie...
Microsurgery, 2015
Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema. From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II-III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and L...