The importance of indocyanine green near‐infrared fluorescence angiography in perfusion assessment in vascularized omentum lymphatic transplant

Coriddi, Michelle; Kenworthy, Elizabeth; Weinstein, Andrew L.; Mehrara, Babak J.; Dayan, Joseph H.

doi:10.1002/jso.25126

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…Furthermore, ischemic areas of native omentum may be present upon transfer, decreasing the amount of flap available to be split. Coriddi et al demonstrated 53.9% of patients had significant portions of ischemic omentum requiring removal of portions of the flap, regardless of history of abdominal surgery (Coriddi et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…43 More recently, vascularized omentum lymphatic transplant and mesenteric node transfer have eliminated the risk of donor site lymphedema. 44,45 The omentum also provides a large surface area that may be beneficial in certain cases and can be split into 2 flaps, one placed proximally and one distally (Fig. 5).…”

Section: Frontiers In Lymphatic Reconstructionmentioning

confidence: 99%

Frontiers in Oncologic Reconstruction

Samra¹,

Sobti²,

Nelson

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Objectives: The authors seek to highlight some of the ongoing challenges related to complex oncologic reconstruction and the current solutions to these problems. Summary: The standard of care in reconstruction following oncologic resection is continually evolving. Current frontiers in breast reconstruction include addressing animation deformity through prepectoral reconstruction, offering autologous reconstruction to patients with limited donor sites, and improving postoperative sensation with innervation of free tissue transfer. Facial nerve reconstruction and contour defects pose an ongoing challenge in patients undergoing parotidectomy requiring complex nerve transfers and autologous reconstruction. Lymphedema is not a monolithic disease, and as our understanding of the pathophysiology improves, our surgical algorithms continue to evolve.

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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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The importance of indocyanine green near‐infrared fluorescence angiography in perfusion assessment in vascularized omentum lymphatic transplant

Abstract: Normal flap perfusion is a requisite for successful VOLT harvest. However, over half the patients had some degree of abnormal perfusion irrespective of prior abdominal surgery. Indocyanine green angiography is an important tool in ensuring a healthy lymphatic reconstruction.

Cited by 9 publications

References 6 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

Frontiers in Oncologic Reconstruction

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

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