Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema

Pedro Ciudad, Oscar J Manrique, Shivprasad Date, Mouchammed Agko, John Jaime Perez Coca, Wei-Ling Chang, Federico Lo Torto, Fabio Nicoli, Michelle Maruccia, Javier López Mendoza, Hung-Chi Chen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND: Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.

PATIENTS AND METHODS: Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).

RESULTS: The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P < 0.05). No episode of infection was noted postoperatively.

CONCLUSIONS: Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.

Original languageEnglish (US)
Pages (from-to)771-779
Number of pages9
JournalMicrosurgery
Volume37
Issue number7
DOIs
StatePublished - Oct 2017
Externally publishedYes

Fingerprint

Lymphedema
Extremities
Lymph Nodes
Tissue Donors
Upper Extremity
Lower Extremity
Pelvic Neoplasms
Therapeutics
Elbow
Wrist
Ankle
Drainage
Knee
Morbidity
Infection

Keywords

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Free Tissue Flaps/blood supply
  • Gastroepiploic Artery/surgery
  • Humans
  • Laparoscopy/methods
  • Lower Extremity/surgery
  • Lymph Nodes/surgery
  • Lymphedema/diagnosis
  • Lymphoscintigraphy/methods
  • Middle Aged
  • Preoperative Care/methods
  • Quality of Life
  • Recovery of Function/physiology
  • Risk Assessment
  • Sampling Studies
  • Severity of Illness Index
  • Tissue and Organ Harvesting/methods
  • Treatment Outcome

Cite this

Ciudad, P., Manrique, O. J., Date, S., Agko, M., Perez Coca, J. J., Chang, W-L., ... Chen, H-C. (2017). Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. Microsurgery, 37(7), 771-779. https://doi.org/10.1002/micr.30168

Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. / Ciudad, Pedro; Manrique, Oscar J; Date, Shivprasad; Agko, Mouchammed; Perez Coca, John Jaime; Chang, Wei-Ling; Lo Torto, Federico; Nicoli, Fabio; Maruccia, Michelle; López Mendoza, Javier; Chen, Hung-Chi.

In: Microsurgery, Vol. 37, No. 7, 10.2017, p. 771-779.

Research output: Contribution to journalArticle

Ciudad, P, Manrique, OJ, Date, S, Agko, M, Perez Coca, JJ, Chang, W-L, Lo Torto, F, Nicoli, F, Maruccia, M, López Mendoza, J & Chen, H-C 2017, 'Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema', Microsurgery, vol. 37, no. 7, pp. 771-779. https://doi.org/10.1002/micr.30168
Ciudad, Pedro ; Manrique, Oscar J ; Date, Shivprasad ; Agko, Mouchammed ; Perez Coca, John Jaime ; Chang, Wei-Ling ; Lo Torto, Federico ; Nicoli, Fabio ; Maruccia, Michelle ; López Mendoza, Javier ; Chen, Hung-Chi. / Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. In: Microsurgery. 2017 ; Vol. 37, No. 7. pp. 771-779.
@article{b49cb5e5e258431aa255ce0e697f028c,
title = "Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema",
abstract = "BACKGROUND: Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.PATIENTS AND METHODS: Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).RESULTS: The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5{\%} along the entire limb (P < 0.05). No episode of infection was noted postoperatively.CONCLUSIONS: Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.",
keywords = "Adult, Aged, Female, Follow-Up Studies, Free Tissue Flaps/blood supply, Gastroepiploic Artery/surgery, Humans, Laparoscopy/methods, Lower Extremity/surgery, Lymph Nodes/surgery, Lymphedema/diagnosis, Lymphoscintigraphy/methods, Middle Aged, Preoperative Care/methods, Quality of Life, Recovery of Function/physiology, Risk Assessment, Sampling Studies, Severity of Illness Index, Tissue and Organ Harvesting/methods, Treatment Outcome",
author = "Pedro Ciudad and Manrique, {Oscar J} and Shivprasad Date and Mouchammed Agko and {Perez Coca}, {John Jaime} and Wei-Ling Chang and {Lo Torto}, Federico and Fabio Nicoli and Michelle Maruccia and {L{\'o}pez Mendoza}, Javier and Hung-Chi Chen",
note = "{\circledC} 2017 Wiley Periodicals, Inc.",
year = "2017",
month = "10",
doi = "10.1002/micr.30168",
language = "English (US)",
volume = "37",
pages = "771--779",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
number = "7",

}

TY - JOUR

T1 - Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema

AU - Ciudad, Pedro

AU - Manrique, Oscar J

AU - Date, Shivprasad

AU - Agko, Mouchammed

AU - Perez Coca, John Jaime

AU - Chang, Wei-Ling

AU - Lo Torto, Federico

AU - Nicoli, Fabio

AU - Maruccia, Michelle

AU - López Mendoza, Javier

AU - Chen, Hung-Chi

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2017/10

Y1 - 2017/10

N2 - BACKGROUND: Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.PATIENTS AND METHODS: Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).RESULTS: The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P < 0.05). No episode of infection was noted postoperatively.CONCLUSIONS: Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.

AB - BACKGROUND: Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.PATIENTS AND METHODS: Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).RESULTS: The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P < 0.05). No episode of infection was noted postoperatively.CONCLUSIONS: Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.

KW - Adult

KW - Aged

KW - Female

KW - Follow-Up Studies

KW - Free Tissue Flaps/blood supply

KW - Gastroepiploic Artery/surgery

KW - Humans

KW - Laparoscopy/methods

KW - Lower Extremity/surgery

KW - Lymph Nodes/surgery

KW - Lymphedema/diagnosis

KW - Lymphoscintigraphy/methods

KW - Middle Aged

KW - Preoperative Care/methods

KW - Quality of Life

KW - Recovery of Function/physiology

KW - Risk Assessment

KW - Sampling Studies

KW - Severity of Illness Index

KW - Tissue and Organ Harvesting/methods

KW - Treatment Outcome

U2 - 10.1002/micr.30168

DO - 10.1002/micr.30168

M3 - Article

C2 - 28334445

VL - 37

SP - 771

EP - 779

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 7

ER -