Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Abstract

Background A new technique named “Selected Lymph Node” (“SeLyN”) was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. Methods Bilateral lower‐limb SPECT‐CT was performed in the upper‐limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor‐site complications were recorded and lower‐limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. Results A total of 41 patients underwent a “SeLyN” transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow‐up period of 42.5 months. Conclusions “SeLyN” is a safe and effective technique in selecting the most suitable LNs, minimizing the donor‐site morbidity, and decreasing the overall operating time.

Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

“…In recent years, VLNT results have been proven to be very promising; these early results, however, have yet to be fully understood and evaluated [ 17 , 18 , 19 ]. While numerous articles describe the successful use of VLNT for lymphedema patients [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ], there is a small number of articles in the literature regarding VLNT flap characteristics that might influence or even favor its final outcomes.…”

“…All female patients at the age of 18 years old or above, suffering from upper limb BCRL stage I, II, or III according to the Staging System of the International Society of Lymphology [ 1 ], were eligible to be included in the study. All patients could be candidates for a lymph node transfer operation, unless they were being subjected to an active cancer or metastatic disease treatment, were diagnosed with a bilateral upper limb lymphedema, or had a history of bilateral breast cancer, history of primary lymphedema, limb edemas of different etiologies, coagulopathy, pregnancy, body mass index above 35 kg/m 2 , alcohol or drug abuse, or were unable to comply with the proposed treatment and follow-up protocol [ 12 ]. Sixty-four out of 65 consecutive female patients were finally included in the study.…”

“…Bilateral lower limb 99m Tc-nanocolloid planar and SPECT-CT lymphoscintigraphy was preoperatively performed, to map the superficial inguinal LNs and select the groin related to the limb of the best lymphatic drainage. The “SeLyN” technique protocol [ 12 ] was meticulously applied in all patients’ inguinal areas, and a handheld Doppler indicated which of the superficial inferior epigastric artery (SIEA), the superficial circumflex iliac artery (SCIA), or its perforator (SCIP) represented the dominant pedicle of the selected flap.…”

“…A recent study introduced a new technique, the “Selected Lymph Node” (“SeLyN”) technique, which identifies the most suitable functional lymph nodes (LNs) of the inguinal area guided by a SPECT-CT radiocolloid lymphoscintigraphy. In this study, it was concluded that “SeLyN” is an effective and safe technique, with a shortened overall operating time, yielding improved outcomes and reduced donor-site morbidity [ 12 ].…”

“…Despite the fact that numerous studies assert the efficacy of VLNT in BCRL patients [ 7 , 9 , 10 , 12 , 13 , 14 ], the unpredictable favorable outcome and the exact functional mechanism remain a matter of debate [ 13 ]. In terms of lymphatic reconstruction, many aspects of these microsurgical procedures and their precise role in lymphedema treatment are yet to be elucidated.…”