Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema

Kenworthy, Elizabeth; Nelson, Jonas A.; Verma, Richa; Mbabuike, JeanJacques; Mehrara, Babak J.; Dayan, Joseph H.

doi:10.1002/jso.25033

Cited by 50 publications

(52 citation statements)

References 25 publications

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“…The safety of omental node donor site for lymphedema have been demonstrated in larger series by Kenworthy et al ( n = 38) with a follow up of 11 months, Ciudad et al ( n = 36) with a follow up of 26 months, and Nguyen et al ( n = 42) with a follow up of 14 months (Ciudad, Manrique, Date, Sacak, et al, ; Kenworthy et al, ; Nguyen et al, ). The most feared abdominal complications, such as chyloperitoneum, internal hernia, omental infarction, small bowel obstruction, and donor site infection, have not been found.…”

Section: Discussionmentioning

confidence: 94%

“…The bidirectional drainage pattern of the in situ omentum requires dual venous anastomosis to restore a physiologic state. Several authors have cited venous hypertension, and subsequent congestion leading to flap loss in omental flaps (Coriddi et al, ; Kenworthy et al, ; Nguyen et al, ). If the flap were to be split, a total of four venous anastomosis would have to be performed.…”

Section: Discussionmentioning

confidence: 99%

“…The use of right gastroepiploic–vascularized lymph node (RGE‐VLN) for lymphedema, first described by Goldsmith in 1967, has seen applications in upper and lower extremity lymphedema (Chu, Allen Jr., Wu, & Cheng, ; Ciudad et al, ; Ciudad et al, ; Ciudad et al, ; Cook, Sasor, Tholpady, & Chu, ; Coriddi, Kenworthy, Weinstein, Mehrara, & Dayan, ; Egorov et al, ; Goldsmith, De los Santos, & Beattie Jr, ; Kenworthy et al, ; Nguyen et al, ). Transplantation of RGE‐VLN may function through a variety of proposed mechanisms.…”

Section: Introductionmentioning

confidence: 99%

“…Egrov described a method by which omental nodes were placed via a longitudinal incision along the extremity by a single anastomosis (Egorov et al, ). In order to distribute lymphatic tissue, Kenworthy et al described a technique utilizing the omentum split by its vascular arcade into two separate groups of lymphatic tissue, transplanted proximally and distally at two remote sites with separate anastomosis (Kenworthy et al, ). Herein we describe our novel RGE‐VLN transfer combining the two concepts where the entire omentum is evenly distributed with an additional distal venous anastomosis, previously undescribed in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…The risk of internal hernia or omental infarction is reduced by avoiding partial harvest. The additional venous anastomosis further facilitates lymphatic clearance and restores the physiologic bidirectional venous drainage of the omentum, thereby avoiding venous hypertension common to these flaps (Coriddi et al, ; Kenworthy et al, ; Nguyen et al, ). The proximal and distal venous connections of the free RGE‐VLN flap resemble a “String of Pearls.” We will describe the surgical technique in upper and lower extremity lymphedema approached via a longitudinal incision in two case reports of the upper and lower extremity.…”

Section: Introductionmentioning

confidence: 99%

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The “String of Pearls” technique for increased surface area and lymphedematous fluid drainage in right gastroepiploic‐vascularized lymph node transfer: A report of two cases

et al. 2019

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We present our "String of Pearls" technique for upper and lower extremity lymphedema based off the right gastroepiploic artery. The entire laprascopically harvested omentum is placed through a longitudinal incision at the lymphedematous area, and anastomosed proximally, with additional distal venous outflow. This approach preserves the native lymphaticovenous architecture, distributes free lymphatic tissue along the axis of the extremity, and allows for scar release. The additional vein serves to restore bidirectional physiologic drainage inherent in the omentum and providing further lymphaticovenous drainage. We present two cases of upper and lower extremity lymphedema as a result of malignancy treated using this method. The first case was a result of breast cancer in a 55-year-old female with orthotopically placed omentum, and the second case a result of malignant nodular fasciitis in the distal lower extremity in a 56-year-old female with distally placed omentum. No complications occurred.At 3 months follow up, there is a 25% and 28% reduction in lower and upper extremity volume, respectively, with no recurrent cellulitis episodes. The safety and feasibility of placement of the entire omentum longitudinally with additional venous anastomosis are apparent. However, long-term studies are required.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The “String of Pearls” technique for increased surface area and lymphedematous fluid drainage in right gastroepiploic‐vascularized lymph node transfer: A report of two cases

et al. 2019

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Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

et al. 2021

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Background: Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain.Aim: To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods.Methods and Results: A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment. Conclusion:This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.

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Intra‐abdominal lymph node flaps in lymphedema therapy: An anatomical guide to donor site selection

Daniel

Sonnenberg

Stern

et al. 2021

Journal of Surgical Oncology

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Background: Secondary lymphedema is a leading sequela of cancer surgery and radiotherapy. The microsurgical transfer of lymph node flaps (LNFs) to affected limbs can improve the symptoms. The intra-abdominal cavity contains an abundant heterogenic source. The aim of this study is to aid selection among intraabdominal LNFs.Methods: Eight LNFs were harvested in a microsurgical fashion at five sites in 16 cadavers: gastroepiploic, jejunal, ileal, ileocolic, and appendicular. These flaps were compared regarding size, weight, arterial diameter, and lymph node (LN) count after histologic verification.Results: One hundred and sixteen flaps were harvested. The exposed area correlated with the flap weight and volume (r 2 = 0.86, r = 0.9). While gastroepiploic LNFs (geLNFs) showed the highest median weight of 99 ml, the jejunal LNFs (jLNFs) had the highest density with 3.8 LNs per 10 ml. The most reliable jLNF was 60 cm from the ligament of Treitz. Three or more LNs were contained in 94% of the jejunal, 88% of the ileal/ileocolic, and 63% of the omental LNs.The ileocolic LNF had the largest arterial diameter of 3 mm, yet the smallest volume.Conclusions: jLNF and ileal LNF provide a reliable, high LN density for simultaneous, smaller recipient sites. geLNFs are more suitable for larger recipient sites.

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Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema

Abstract: Double VOLT to the mid-level and proximal extremity is a safe and viable option.

Cited by 50 publications

References 25 publications

The “String of Pearls” technique for increased surface area and lymphedematous fluid drainage in right gastroepiploic‐vascularized lymph node transfer: A report of two cases

The “String of Pearls” technique for increased surface area and lymphedematous fluid drainage in right gastroepiploic‐vascularized lymph node transfer: A report of two cases

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

Intra‐abdominal lymph node flaps in lymphedema therapy: An anatomical guide to donor site selection

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