Free gastroepiploic lymph nodes and omentum flap for treatment of lower limb ulcers in severe lymphedema: Killing two birds with one stone

Abstract

Background and ObjectivesIn patients with lymphedema, the disruption of the lymphatic network increases skin turgor and fibrosis of subcutaneous tissue, delays wound healing, causing recurrent ulcerations and infections. In these cases, management of ulcers can be challenging.MethodsBetween January 2016 and June 2018, patients presenting with lymphedema were enrolled at our Institution. We selected patients with severe lymphedema and ulcers of lower limbs and we performed a surgical approach, involving free gastroepiploic lymph nodes and omentum flap, harvested through laparoscopy.ResultsWe enrolled 135 patients presenting for lymphedema. Among them, 10 eligible cases underwent excision of the ulcer and reconstruction with omentum flap. Mean age was 57.8 years and average follow‐up 24.1 months. Circumferences and skin tonicity significantly decreased from the preoperative period. Lymphoscintigraphy showed improvement of the lymphatic drainage and restoration of lymphatic network. No episodes of infection were recorded in the postoperative period.ConclusionsOur combined procedure merges free flap techniques and lymphedema surgery: omentum covers the defect while providing a new source of lymph nodes, improving the lymphatic networks of the affected limb. This technique can highly increase the quality of life of the patient in a single‐stage operation with fast recovery and low donor site morbidity.

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

“…Inclusion criteria were secondary lymphedema of lower limbs, stage II‐III, progressive swelling of the limb regardless of decongestive therapy and skin tonicity above 60 (Bolletta et al, 2020; Chen, O'Brien, Pribaz, & Roberts, 1988; Di Taranto et al, 2020; Di Taranto, Chen, Elia, et al, 2019). Exclusion criteria were primary lymphedema, lymphedema of the upper limbs, previous lymphedema‐related or other surgeries of the involved limb and the presence of spontaneous ulcer with lymph leakage.…”

“…Patients were selected from among those diagnosed for lymphedema at our Institution between January 2016 and October 2018. The first consecutive patients enrolled in the study in the first time frame, between 2016 and 2017, were treated with VLNT followed by SL (group I), as described in other reports from our group (Bolletta et al, 2020; Ciudad et al, 2017; Di Taranto et al, 2020). This group was the control group of our study or VLNT group.…”

“…The circumference reduction rate (CRR) was used to compare preoperative and postoperative findings. The CRR was defined as the difference between the preoperative circumferences of the affected and healthy limbs minus the difference between the postoperative circumferences of the affected and healthy limbs, divided by the preoperative difference, ×100, as previously described (Di Taranto et al, 2020; Maruccia et al, 2019).…”

“…In the early stages of pathological process, conservative and nonsurgical treatment can be advised, but in more advanced stages the surgical treatment becomes necessary (Bolletta, Di Taranto, Chen, et al, 2020; Ciudad et al, 2019; Di Taranto, Chen, Elia, et al, 2020). Early proposed surgical procedures were often invasive and disfiguring.…”

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

“…Lymph node flap transfer has gradually gained popularity for the treatment of both upper and lower limb lymphedema (Althubaiti, Crosby, & Chang, 2013;Azuma, Yamamoto, & Koshima, 2013;Becker, 2016;Chang, Masià, & Smith, 2018;Cheng, Koshima, Chang, & Masia, 2017;Giudice et al, 2017;Gould, Mehrara, Neligan, Cheng, & Patel, 2018;Kung et al, 2017;Lin et al, 2009;Masià, Pons, & Rodríguez-Bauzà, 2016;Patel, Lin, & Cheng, 2015;Schaverien, Badash, Patel, Selber, & Cheng, 2018;Silva & Chang, 2016). Several donor sites for lymph node flaps have been described, including the abdominal area Ciudad, Kiranantawat, Sapountzis, et al, 2015;Ciudad, Manrique, Date, Agko, et al, 2017;Ciudad, Manrique, Date, Sacak, et al, 2017;Di Taranto, Chen, Elia, et al, 2019;Di Taranto, Elia, Amorosi, et al, 2018;Leuzzi et al, 2018;Maruccia et al, 2019).…”