Flow-through Omental Flap for Vascularized Lymph Node Transfer: A Novel Surgical Approach for Delayed Lymphatic Reconstruction

Johnson, Anna Rose; Bravo, Miguel G.; Granoff, Melisa D; Kang, Christine O.; Critchlow, Jonathan F.; Tsai, Leo L.; Lee, Bernard T.; Singhal, Dhruv

doi:10.1097/gox.0000000000002436

Cited by 12 publications

(19 citation statements)

References 10 publications

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“…By decreasing flap inflow and increasing flap outflow, the omental flow-through approach resolves this issue. 3 In this case, we used the flowthrough method and discovered no postoperative venous hypertension or stealing effect. However, during the arterial phase of the postoperative CT scan, an early enhancement of the omental and limb venous system was observed.…”

Section: Discussionmentioning

confidence: 74%

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Five-year Follow-up Outcome of Total Omental Lymph Node Flap Transfer in Primary Lymphedema Patient

Yodrabum

Poungjantaradej

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Lymphedemas are caused by the accumulation of protein-rich fluid in the interstitial space, resulting from lymphatic system obstruction. In recent years, omentum flap transfer has gained popularity as a treatment for lymphedema due to its immunogenic and lymphangiogenic properties, which aid in reducing infection rate and volume. Moreover, omental flaps have angiogenesis capabilities, which can aid in successful chronic wound covering. Using a flow-through procedure after omental flap transfer can help reduce complications including venous congestion and steal phenomenon at the recipient site. We present a long-term follow-up of a case of primary lymphedema treated with omental flap transfer with flow-through figuration, demonstrating a gradual decrease in volume, reduced infection rate, and chronic wound coverage. This case report illustrates intriguing postoperative compartment effect and vascular concerns.

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Section: Discussionmentioning

confidence: 74%

“…2 Venous congestion is a common complication after omental flap microvascular anastomosis. 3 The flowthrough configuration in the omental flap creates a natural vasculature flow and reduced venous congestion. 4 The purpose of this study was to demonstrate our experience in total omental flow-through flap in lower extremity lymphedema.…”

mentioning

confidence: 99%

Five-year Follow-up Outcome of Total Omental Lymph Node Flap Transfer in Primary Lymphedema Patient

Yodrabum

Poungjantaradej

2023

Plastic and Reconstructive Surgery - Global Open

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“…Five studies utilized gastroepiploic VLNTs, and of those only one mentioned supercharging. 16 The wrist was the recipient site of choice in 48.0% ( n = 331/689) and the axilla in 52.0% ( n = 358/689) of patients included. Among included patients, the overall weighted CRR was 46.7% (range: 24.9–58.7), with an average follow-up of 38.0 months, and the overall weighted EVR was 46.2% (19.3–58.8), with an average follow-up of 27.4 months.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies reported using the wrist as a recipient site for VLNT, totaling 331 patients. 9 12 16 17 18 19 20 21 22 23 24 25 26 27 The mean age of patients was 54.2 years (range: 48.0–57.5) and the mean BMI was 27.6 kg/m 2 (range: 25.9–32.6). On average, the mean time from diagnosis of BCRL to VLNT treatment was 2.08 years (range: 1.6–12.1) and 81.6% ( n = 177/217) received adjuvant radiotherapy to either the lymph node basin or breasts.…”

Section: Resultsmentioning

confidence: 99%

Axilla versus Wrist as the Recipient Site in Vascularized Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis

Chocron

Azzi

Bouhadana

et al. 2021

J Reconstr Microsurg

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Background Vascularized lymph node transfers (VLNT) are being used with increasing frequency for the treatment of breast cancer-related lymphedema (BCRL). However, there is a lack of consensus in the surgical field as to which recipient site should be utilized. We, therefore, aim to assess the evidence comparing the wrist and axilla as recipient sites for VLNT in BCRL. Methods We conducted a systematic literature review to compare the wrist and axilla as recipient sites for VLNT in BCRL. Demographic data, as well as circumference reduction rate (CRR), excess volume reduction (EVR), postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate were extracted from included studies. These were compared through a meta-analysis. Results A total of 37 studies met the inclusion criteria for a total of 689 patients. VLNTs to the wrist and axilla resulted in a decrease in CRR of 42.1 and 51.5%, and a decrease in EVR of 35.6 and 48.8%, respectively. However, our meta-analysis showed no significant differences between CRR or EVR and between wrist and axilla as recipient sites. Similarly, we found no differences in postoperative decrease in infections per year, postoperative discontinuation of compression garments, and overall pooled complication rate. Conclusion These data suggest noninferiority between the wrist and axilla as recipient sites for VLNT in the context of BCRL. In the absence of randomized, prospective data, we hope these results can be used as an evidence-based reference and facilitate future studies.

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“…8 In the upper extremity, we proposed a novel inset with a second arterial and venous anastomosis, thereby recreating the omentum’s natural flowthrough physiology. 5 In this case series, we describe our lower extremity approach to omental vascularized lymph node transplantation with a middle leg recipient site and flowthrough configuration.…”

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confidence: 99%

Flowthrough Omental Flap for Vascularized Lymph Node Transplant of the Lower Extremity

Lee

Granoff

Pardo

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: Vascularized lymph node transplantation is a surgical approach for the treatment of chronic lymphedema. However, there is no clinical standard for flap placement nor vascular anastomoses. The authors propose a novel flowthrough configuration for an omental vascularized lymph node transplant in the popliteal space. To prepare the popliteal space for an omental free flap, the medial popliteal fat pad and medial head of the gastrocnemius muscle were debulked. Venous anastomoses were completed with vein couplers, joining the right gastroepiploic vein to the medial sural venae comitantes and the left gastroepiploic vein to the lesser saphenous vein. Arterial anastomoses were hand sewn, joining the right gastroepiploic artery to the proximal medial sural artery and the left gastroepiploic artery to the distal medial sural artery, to create the flowthrough configuration. A retrospective review of patients who underwent this procedure at a single institution was performed. Six patients with chronic lymphedema of the lower extremity underwent vascularized lymph node transplantation from June of 2019 to November of 2020. Five patients underwent at least 3 months of postoperative surveillance, with no postoperative complications reported. In this technique contribution, the authors describe a novel flowthrough configuration for an omental free flap to the popliteal space. The popliteal space offers an aesthetically favorable recipient location when appropriately prepared. The medial sural vessels are ideal recipient vessels for the flowthrough omental flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Flow-through Omental Flap for Vascularized Lymph Node Transfer: A Novel Surgical Approach for Delayed Lymphatic Reconstruction

Abstract: Supplemental Digital Content is available in the text.

Cited by 12 publications

References 10 publications

Five-year Follow-up Outcome of Total Omental Lymph Node Flap Transfer in Primary Lymphedema Patient

Five-year Follow-up Outcome of Total Omental Lymph Node Flap Transfer in Primary Lymphedema Patient

Axilla versus Wrist as the Recipient Site in Vascularized Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis

Flowthrough Omental Flap for Vascularized Lymph Node Transplant of the Lower Extremity

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