Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema

Hassanein, Aladdin H.; Danforth, Rachel; DeBrock, Will; Mailey, Brian; Lester, Mary; Socas, Juan

doi:10.1016/j.bjps.2020.03.017

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…VLNT requires flap dissection for the harvest of the donor nodes (e.g., right gastroepiploic/omentum, supraclavicular, jejunum, groin, deep inferior epigastric artery nodes). (Cheng et al, 2013; Coriddi et al, 2017; Hassanein et al, 2020; Maldonado et al, 2017) Recipient vessels in the affected extremity (e.g., medial sural artery, radial artery) need to be procured. (Smith, Molina, Dayan, et al, 2017; Smith, Molina, Dayan, Kim, et al, 2017) An arterial anastomosis and at least 1–2 venous anastomosis are performed and the flap is buried or or skin grafted.…”

Section: Discussionmentioning

confidence: 99%

“…Our study found similarly low complication rates as previously published studies. (Chang, 2010; Chang et al, 2013; Chang et al, 2020; Cheng et al, 2018; Cook et al, 2021; Hassanein et al, 2020; Schaverien & Coroneos, 2019) However, most studies on lymphatic procedures are focused on outcomes specific to lymphedema rather than complications such as those tracked by NSQIP. Overall, lymphatic procedures have low 30‐day complication rates and are well tolerated by patients.…”

Section: Discussionmentioning

confidence: 99%

“…(Brorson & Svensson, 1998) Operative treatment includes excisional (skin/subcutaneous resection, liposuction) and physiologic procedures vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). (Brorson, 2003; Carl et al, 2017; Chang et al, 2013; Cook et al, 2021; Cook & Hassanein, 2021; Dayes et al, 2013; Hassanein et al, 2020; Hassanein, Sacks, & Cooney, 2017; Hoffner et al, 2018; Schaverien et al, 2018; Silva & Chang, 2016) VLNT and LVB are both microsurgical physiologic procedures performed to enhance lymph transit in the affected extremity. (Chang et al, 2013) Improvement in limb volume and patient‐reported outcomes have been described (Boccardo et al, 2014; Carl et al, 2017; Coriddi et al, 2020; Klernäs et al, 2020; Raju & Chang, 2015) There is no consensus on timing of treatment, preferred operation, or the order of interventions between VLNT and LVB (Scaglioni et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

et al. 2021

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Introduction Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30‐day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database. Methods NSQIP was queried (2012–2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30‐day morbidities, and hospital length of stay. Results The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co‐morbidities between the groups (p = 0.26). 30‐day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21). Conclusions Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon's preference and experience as the operations have similar complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

et al. 2021

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“…2 Management of lymphedema includes compression, microsurgical physiological procedures, and excisional procedures such as liposuction. 3,4 Patients with BCRL typically have had breast cancer managed with mastectomy or partial mastectomy and often undergo breast reconstruction. Fat grafting is an adjunct in breast reconstruction to fill contour deficiencies; 78,000 cases are performed annually in the United States.…”

Section: Introductionmentioning

confidence: 99%

The Lymphedematous Limb as a Donor Site for Breast Fat Grafting

Ahmed,

Mohan,

Hulsman

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Breast cancer–related lymphedema results in chronic upper limb swelling with subcutaneous deposition of fluid and fibroadipose tissue. Morbidity includes psychosocial distress, infection, and difficulty using the extremity. Operative management includes excisional procedures such as suction-assisted lipectomy to reduce abnormal subcutaneous fibroadipose tissue to improve limb volume. Patients who have had postmastectomy breast reconstruction often benefit from fat grafting. This report introduces the concept of fat grafting the breast using the lymphedematous arm as a donor site. This technique improves the volume of the limb by removing the excess subcutaneous adipose, and at the same time reconstructs the breast without adding a donor site not related to the breast cancer–related lymphedema.

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“…Lymphedema is managed nonsurgically (compression, decongestive therapy) and surgically (excisional and microsurgical procedures). 5 , 6 , 7 Current treatments may variably improve limb size and symptoms but do not cure lymphedema. 5 Progressive limb enlargement from interstitial fluid retention, followed by inflammation and fibrosis over time are difficult to reverse.…”

Section: Introductionmentioning

confidence: 99%

Topical tissue nanotransfection of Prox1 is effective in the prophylactic management of lymphedema

Mohan,

Khan,

Neumann

et al. 2024

Molecular Therapy - Nucleic Acids

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Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema

Cited by 12 publications

References 4 publications

Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

The Lymphedematous Limb as a Donor Site for Breast Fat Grafting

Topical tissue nanotransfection of Prox1 is effective in the prophylactic management of lymphedema

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