Deep inferior epigastric lymph node basin: Analysis of novel donor site for vascularized lymph node transfer among 10 consecutive patients

Ochoa, Oscar; Metzner, Michael; Theoharis, Constantine; Chrysopoulo, Minas; Pisano, Steven; Nastala, Chet; Ledoux, Peter; Arishita, Gary; Garza, Ramon; Snider, Ted

doi:10.1002/micr.30372

Cited by 7 publications

(9 citation statements)

References 33 publications

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“…The surgical options for the treatment of refractory chylous ascites have resulted in successful outcomes only in the cases where the underlying pathophysiology was suitably addressed, while in rest the indication has now been restricted to short term palliation (Boccardo et al, 2007). Considering the pathophysiologic principles of chylous ascites, our novel method of vascularized extra‐peritoneal DIE‐LCF connected to a pedicle GE‐VLN flap possibly works by bypassing the intra‐abdominal lymphatic obstruction and providing alternate physiological pathway for lymphatic transport (Deldar et al, 2016; Felmerer et al, 2002; Ochoa et al, 2019; Raju & Chang, 2015). Ochoa et al described the DIE lymph node basin located 6–8 cm from the pedicle origin in the preperitoneal space, proximal to its bi/ trifurcation into medial and lateral branches (Ochoa et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Considering the pathophysiologic principles of chylous ascites, our novel method of vascularized extra‐peritoneal DIE‐LCF connected to a pedicle GE‐VLN flap possibly works by bypassing the intra‐abdominal lymphatic obstruction and providing alternate physiological pathway for lymphatic transport (Deldar et al, 2016; Felmerer et al, 2002; Ochoa et al, 2019; Raju & Chang, 2015). Ochoa et al described the DIE lymph node basin located 6–8 cm from the pedicle origin in the preperitoneal space, proximal to its bi/ trifurcation into medial and lateral branches (Ochoa et al, 2019). They found a mean number of lymph nodes of 2.6 with a mean lymph node diameter of 3.7 mm (Ochoa et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…A lymphatic “cable” flap (LCF) or chain‐linked flap, based on the principles of VLNT is being proposed for the treatment of chylous ascites. The deep inferior epigastric vascular pedicle with its contiguous adipose and lymphatic tissue (Deldar et al, 2016; Felmerer et al, 2002; Ochoa et al, 2019) are transferred intra‐abdominally connected to the gastroepiploic vascularized lymph node (GE‐VLN) flap to provide an alternate extra peritoneal pathway for draining the chylous fluid. Herein, we present two patients in which this procedure was performed with successful outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Care was taken to carefully dissect the pedicle from the posterior aspect of the muscle. This enabled us to include the DIE artery and vein, surrounding adipofascial lymphatic tissue, and the deep inferior epigastric lymph node basin (Ochoa et al, 2019). The dissection was extended cranially to achieve a long pedicle.…”

Section: Introductionmentioning

confidence: 99%

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The deep inferior epigastric lymphatic cable flap connected to gastroepiploic lymph node flap for treatment of refractory chylous ascites: Report of two cases

et al. 2021

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Chylous ascites is the leakage of lipid‐rich lymph into the peritoneal cavity usually due to disruption of lymphatics or increased peritoneal lymphatic pressure. Various surgical options have been proposed to treat chylous ascites but most have shown suboptimal outcomes. The gastroepiploic vascularized lymph node (GE‐VLN) flap has been described previously for the treatment of lymphedema. In chylous ascites, this flap could provide an alternate drainage pathway for the intraperitoneal chylous fluid. The purpose of this report is to present another option for the microsurgical treatment of refractory chylous ascites. Herein, we report two patients with refractory chylous ascites secondary to cancer who have undergone deep inferior epigastric‐based lymphatic “cable” flap (DIE‐LCF) connected to a pedicle GE‐VLN flap. Patients were followed‐up for a minimum of 2 years. Within the first 3 months following surgery, the patient's nutritional parameters improved along with drastic reduction of ascites. At 2 years follow‐up postoperative abdominal circumference decreased significantly. None required further peritoneal paracentesis and all patients were free of chylous ascites symptoms. In conclusion, the DIE‐LCF connected to a pedicle GE‐VLN flap could be a feasible option for the microsurgical treatment of refractory chylous ascites.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The deep inferior epigastric lymphatic cable flap connected to gastroepiploic lymph node flap for treatment of refractory chylous ascites: Report of two cases

et al. 2021

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“…Interestingly, the anterior parietal retroperitoneal route as never been reported neither as a potential lymphatic pathway of dissemination neither as metastatic LN basin. However, recently, Ochoa et al 8 have described for the first time the deep inferior epigastric lymph node (IELN) basin as a potential donor site for vascularized LNs transfer in patients treated for breast cancer reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Inferior epigastric artery lymph nodes: A pathway for systemic dissemination from peritoneal carcinomatosis?

Asmar

Veys

Larsimont

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: We report, for the first time in the literature, a metastatic lymphatic pathway along the inferior epigastric vessels, through the inferior epigastric lymph nodes (IELNs), in patients with peritoneal carcinomatosis (PC). Interestingly, these lymph nodes (LNs) in the anterior retroperitoneum were not detectable on preoperative imaging. They may, however, represent a pertinent systemic dissemination pathway for PC. Patients and Methods: In patients undergoing indocyanine green-fluorescence imaging during cytoreductive surgery for PC, an incidental finding of a hyperfluorescent LN, harboring metastatic tumorous cells, around the inferior epigastric artery was made. Results: In three out of five patients with clear fluorescent hotspot, the harvested LN was harboring metastatic cancerous cells. None of these nodes, whether negative or positive, was visible on any preoperative imaging modalities. A protocol to sample, in a systematic manner, the IELN in patients with PC, is currently being devised at our institution. Conclusion: These lymphatic nodes basin and channels might reveal to be a potential passage from peritoneal metastasis to the extraperitoneal lymphatic compartment, representing an independent pathway for cancerous cell dissemination. This will bring us to further investigate the prevalence and the prognostic significance of these LNs.

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Combined lymphovenous anastomosis and deep inferior epigastric perforator flap with lymphatic tissue preservation for defect reconstruction and lymphedema‐lymphocele prevention after medial thigh sarcoma resection: A case report

et al. 2020

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Soft tissue sarcomas are a rare group of malignant tumors that often require an extensive surgical resection to be safely treated. When they are localized in the upper medial thigh, this treatment inevitably leads to large defects frequently causing a series of early and late postoperative complications. Among these, lymphocele and lymphedema are rather common and should try to be avoided. Many solutions with a demonstrated efficacy have been described for this purpose after groin dissection procedure, ranging from lymphovenous anastomosis to pedicled or free flaps. Anyway, there is much less information regarding the medial thigh. Here we present a case of resected sarcoma involving the adductors compartment reconstructed using a pedicled deep inferior epigastric (DIEP) flap with lymphatic tissue transfer, combined with preventive lymphovenous anastomosis (LVA) performed at the superior‐edge‐of‐the‐knee incision (SEKI) point. A 58‐year‐old patient presented a 10 cm × 12 cm soft tissue defect after margin free sarcoma removal. To fill this defect, we harvest a 24 × 9 cm pedicled DIEP flap conserving its lymphatic vessels running from the upper margin to the right groin lymphnodes. Then we rotated it maintaining the lymphnodes in their original site and moved it through an inguinal tunnel in the area of the defect. The distal part was de‐epithelized and folded down to cover the deeper region. The postoperative course was uneventful and at the 6 months follow up the patient showed a good outcome with no swelling and no signs of tumor relapse. This result therefore may suggest that this kind of combined treatment might be an effective technique to prevent all those complications linked to the impairment of lymphatic system drainage in the proximal medial thigh.

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Deep inferior epigastric lymph node basin: Analysis of novel donor site for vascularized lymph node transfer among 10 consecutive patients

Abstract: Lacking previous description, the deep inferior epigastric lymph node basin is a readily accessible donor site with significant anatomic advantages for potential VLNT during autologous breast reconstruction.

Cited by 7 publications

References 33 publications

The deep inferior epigastric lymphatic cable flap connected to gastroepiploic lymph node flap for treatment of refractory chylous ascites: Report of two cases

The deep inferior epigastric lymphatic cable flap connected to gastroepiploic lymph node flap for treatment of refractory chylous ascites: Report of two cases

Inferior epigastric artery lymph nodes: A pathway for systemic dissemination from peritoneal carcinomatosis?

Combined lymphovenous anastomosis and deep inferior epigastric perforator flap with lymphatic tissue preservation for defect reconstruction and lymphedema‐lymphocele prevention after medial thigh sarcoma resection: A case report

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