Anatomical Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomographic Angiography

Abstract

When using the right gastroepiploic artery donor site for vascularized lymph node transfer, the plastic surgeon should anticipate using a pedicle length of 4 cm, a total flap length of 9 cm, and 3 cm of surrounding tissue to obtain at least three lymph nodes for transfer. Computed tomographic angiography is an effective imaging modality that can be used for patient-specific surgical navigation before vascularized lymph node transfer.

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

“…The anatomical basis for harvesting a lymph node flap based on the right gastroepiploic vessels have been highlighted by Howell et al (2018). General surgeons can safely take the right gastroepiploic artery and surrounding 3 cm of tissue to include two or three lymph nodes when planning for a right gastroepiploic vascularized lymph node transfer.…”

“…General surgeons can safely take the right gastroepiploic artery and surrounding 3 cm of tissue to include two or three lymph nodes when planning for a right gastroepiploic vascularized lymph node transfer. Moreover, this lymphosome confers the additional advantage of being located within the abdomen, in an area without a known risk of causing iatrogenic lymphedema and without leaving visible scars (Howell et al, 2018). The use of minimally invasive surgery techniques for flap harvest reduces donor site morbidity and allows a faster recovery.…”

Discussion: Nanofibrillar Collagen Scaffold Enhances Edema Reduction and Formation of New Lymphatic Collectors after Lymphedema Surgery

“…[9][10][11] It is not clear which donor site the authors selected in the study, but if the findings are indeed valid, the synergistic effect of the scaffold would be best coupled to a donor site with the maximal number of lymph nodes. 12 However, the concept does not readily apply to a patient who has had a lymphovenous bypass, as the improvement in a patient's lymphedema occurs through direct outflow through an existing functional pathway, not through regeneration of lymphatic channels. If the nanofibrillar scaffold works in this setting, the scaffold would theoretically be effective even without the lymphovenous bypass or vascularized lymph node transfer.…”

“…9–11 It is not clear which donor site the authors selected in the study, but if the findings are indeed valid, the synergistic effect of the scaffold would be best coupled to a donor site with the maximal number of lymph nodes. 12…”