Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for Breast Cancer-Related Lymphedema

Abstract

Background:The vascularized groin and submental lymph node (VGLN and VSLN) flaps are valuable options in the treatment of lymphedema. This study was to compare outcomes between VGLN and VSLN transfers for breast cancer–related lymphedema.Methods:Between January 2008 and December 2016, VGLN and VSLN transfers for upper limb lymphedema were compared including flap characteristics, flap elevation time, complications, and limb circumference changes.Results:All flaps survived. Similar vein (2.6 versus 3.2 mm; P = 0.3) and artery diameter (2.1 versus 2.8 mm; P = 0.3) and number of lymph nodes (3 versus 4; P = 0.4) were found between VGLN and VSLN groups, respectively. Circumferential reduction rate was higher in VSLN than VGLN (P = 0.04) group. Vascular complication rate with salvage rate was not statistically different between the 2 groups. Donor-site complication and total complication rates were statistically higher in VGLN than VSLN flaps (7.7% versus 0%, P = 0.004; 46.2% versus 23.3%, P = 0.002). At a mean 39.8 ± 22.4 months, the circumferential reduction rate was statistically higher in VSLN than in the VGLN group (55.5 ± 14.3% versus 48.4 ± 23.9%, P = 0.04). Both flaps were effectively decreased in the episodes of cellulitis.Conclusions:Both VGLN and VSLN flaps are valuable surgical options in treating breast cancer–related lymphedema. However, the VSLN flap for breast cancer–related lymphedema is better in providing more significant improvements in limb circumference, a faster flap harvest time, decreased complication rates, and minimal donor-site iatrogenic lymphedema.

Staging and clinical correlations of lymphoscintigraphy for unilateral gynecological cancer–related lymphedema

“…Despite the advances in lymphedema surgery, many controversies regarding diagnosis, staging, and appropriate treatment are still present among medical specialties. Several treatments have been proposed including conservative nonsurgical approach such as complex decongestive therapy, and surgical procedures including Charles procedure, liposuction, lymphovenous anastomosis, and vascularized lymph node transfer . However, the same treatment was reported sometimes having different surgical outcomes in different patients.…”

Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments

“…In 2006 Becker et al popularized for the first time the procedure with the publication of groin VLN transfer for postmastectomy lymphedema [ 72 ]. After that, Cheng and colleagues described anatomic and clinical application of both groin and submental VLN transfer transferred into the distal limb [ 28 , 73 ]. Three recipient sites have been described for upper limb lymphedema such as axilla, elbow and wrist.…”

Response to: Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for Breast Cancer–related Lymphedema

“…Therefore, while reviewing the literature, we were pleased to read a recently published article by Ming-Huei Cheng demonstrating a comparison between 2 lymph node flaps in the management of upper extremity lymphedema. 1 …”