The Lymphatics of the Groin Flap

Vascularized Lymph Node Transfer Based on the Hilar Perforators Improves the Outcome in Upper Limb Lymphedema

“…Conventionally, the flaps with or without a skin component were based on the deep branch of the superficial circumflex iliac artery and dissected as a traditional groin flap is harvested. [7][8][9] However, the deep branch of the superficial circumflex iliac artery plays only a marginal role in the perfusion of the inguinal nodes giving off mainly branches to the muscles in the femoral triangle 17 and vascularizes the skin lateral to the anterior superior iliac spine. As already described by Acland 18 and subsequently stressed out by Cormack and Lamberty, 17 the superficial branch of the superficial circumflex iliac artery is the main supply of the lymph nodes.…”

“…The first clinical application of vascularized inguinal lymph nodes was reported by Clodius et al 7 Transfer of a pedicled groin flap from the contralateral side achieved stable reduction in the circumference of the lymphedematous limb. However, the second patient who received a free groin flap experienced rapid recurrence of lymphedema.…”

“…6 The superficial location of lymph nodes, their association with known vessels, and inconspicuous scar following flap harvest have made the inguinal region a favorite donor site for the harvest of vascularized lymph nodes. [7][8][9] However, this technique has not gained popularity, probably because the numerous variations of the regional vascular anatomy 10 have been associated with risk of flap failure. Furthermore, if the selected vascular pedicle does not directly perfuse the lymph nodes, their function could be jeopardized.…”

Liposuction Gives Complete Reduction of Chronic Large Arm Lymphedema After Breast Cancer

“…Bridging procedures using various rotational flaps from the trunk to the affected limb have been described (38). Omental transposition combining excision and a bridging operation in transferring the omental lymphatics to the affected limb was described by Goldsmith & De Los Santos in 1967 (39).…”

Liposuction in Arm Lymphedema Treatment

“…Various surgical procedures have therefore been proposed to reduce lymphedema, including interventions to the subcutis and deep fascia (13)(14)(15)(16)(17)(18)(19), and skin grafting (20,21). None of these methods gave satisfactory or long-lasting results.…”