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 journalArticlepeer-review

51 Scopus citations


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
Issue number7
StatePublished - Oct 2017
Externally publishedYes


  • 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


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