Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

Jarvis, Nicholas R.; Torres, Ricardo; Ávila, Francisco R.; Forte, Antonio J.; Rebecca, Alanna M.; Teven, Chad M.

doi:10.1002/cnr2.1370

Cited by 8 publications

(9 citation statements)

References 38 publications

(87 reference statements)

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“…The appearance subdomain scores remained relatively constant in patients with fat-dominant disease, possibly because individuals in this cohort likely experienced a dramatic change in their limb volumes following debulking, leading to a major improvement in their perceived appearance that would have occurred prior to VLNT. Overall, the findings from the current study are in concordance with other studies that have reported positive effects of VLNT on patient quality of life [ 10 , 35 , 36 ] . However, in the current study, the beneficial effects may be less directly related to changes in limb volumes and may be more heavily influenced by the reduction in time spent wearing compression garments.…”

Section: Discussionsupporting

confidence: 92%

The Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity

Friedman¹,

Morgenstern²,

Bustos³

et al. 2022

Plast Aesthet Res

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Aim: Although vascularized lymph node transplantation (VLNT) has gained recognition as an effective treatment option for lymphedema, no consensus on the timing of transplant with other lymphatic procedures has been established. The aim of this study is to describe our institutional experience with VLNT, including our staged approach and report postoperative outcomes. Methods: A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted. Patients were divided into fat- or fluid-dominant phenotypes based on preoperative workup. Patients with a minimum of 12-month follow-up were included. Records were reviewed for demographic, intraoperative, and surveillance data. Results: Twenty-three patients underwent VLNT of the upper extremity during the study period, of which eighteen met the study criteria. Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution. Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression, and improvement in quality-of-life scores at twelve months. Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression, and demonstrated improvements in quality-of-life scores in nearly all subdomains. Overall, 17% of patients discontinued compression therapy entirely. Improvement in extremity edema was present in 83% of postoperative MRIs. Conclusion: VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression. Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.

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Section: Discussionsupporting

confidence: 92%

The Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity

Friedman¹,

Morgenstern²,

Bustos³

et al. 2022

Plast Aesthet Res

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“…In our case, omental flap transfer resulted in a significant reduction in infection, resolution of the wound, and a gradual decrease in limb volume over 5 years of follow-up. The vascularized omentum transfers contain lymphoreticular bodies known as milky spots, 5 which drain fluid from the interstitial space 6 The omentum possesses immunologic and angiogenesis capabilities as well. Forte et al 7 noticed a 30%–70% volume reduction within 0.5–4 years.…”

Section: Discussionmentioning

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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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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“…showing that the vascularized omental lymphatic transfer is safe and efficacious (Jarvis et al, 2021;Schaverien et al, 2021). In addition to minimizing the morbidity of the laparotomy through laparoscopic harvesting techniques, there is no risk of donor site lymphedema, and there is increased availability of lymph node tissue (Nguyen & Suami, 2015).…”

Section: T a B L E 1 Patient Demographics And Surgical Detailsmentioning

confidence: 99%

“…There has been a shift towards implementing surgical intervention earlier, attempting to stop the progression of disease leading to permanent fibrosis, with VLNTs becoming more popular (Jarvis et al, 2021; Raju & Chang, 2015). Different VLNTs have been described including inguinal, gastroepiploic, thoracic, supraclavicular, submental and omental (Cheng et al, 2012; Jarvis et al, 2021; Raju & Chang, 2015). Of these, the omental vascularized lymph node transfer has gained interest as of late due to its success at treatment of upper extremity lymphedema and decreased risk of donor‐site lymphedema compared to other recipient sites (Forte et al, 2019; Jarvis et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Lymphedema is a debilitating disease that requires constant maintenance therapy and may be amenable to surgical intervention including lymphovenous bypass (LVB), lymphaticovenous anastomosis (LVA) or a vascularized lymph node transfer (VLNT) (Chang et al, 2018). There has been a shift towards implementing surgical intervention earlier, attempting to stop the progression of disease leading to permanent fibrosis, with VLNTs becoming more popular (Jarvis et al, 2021; Raju & Chang, 2015). Different VLNTs have been described including inguinal, gastroepiploic, thoracic, supraclavicular, submental and omental (Cheng et al, 2012; Jarvis et al, 2021; Raju & Chang, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Concurrent management of lymphedema and breast reconstruction with single‐stage omental vascularized lymph node transfer and autologous breast reconstruction: A case series

et al. 2023

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IntroductionThe omentum has gained recent popularity in vascularized lymph node transfers (VLNT) as well as its novel use as a free flap for autologous breast reconstruction. The omentum has multiple unique advantages. It can be harvested laparoscopically or in an open fashion when utilized with abdominally‐based free flaps. Additionally, it can be split into multiple flaps for simultaneous autologous breast reconstruction with VLNT or for multiple sites of VLNT. We present the safe and advantageous use of the omentum for VLNT with simultaneous autologous breast reconstruction in a series of patients.MethodsFrom the years 2019–2022, patients who underwent breast reconstruction with deep inferior epigastric artery perforator (DIEP) or muscle sparing tram (MS‐TRAM) flaps with concurrent omental VLNT through a mini‐laparotomy or breast reconstruction with Omental Fat‐Augmented Free Flap (O‐FAFF) with concurrent laparoscopic harvesting of omental VLNT were studied. Patient demographics included age, gender, comorbidities, prior radiation or chemotherapy, body mass index, complications, hospital length of stay, and surgical outcomes.ResultsA total of seven patients underwent omental VLNT with breast reconstruction for a total of 12 breasts and eight limbs treated. Three of the patients underwent autologous breast reconstruction using omental free flap. The mean age was 52.3 (range 40–75) years and mean body mass index (BMI) was 29.3 (range 23–38) kg/m2. The flap survival rate was 100%. All the patients had successful reduction of extremity circumference and improvement of symptoms. The range of follow‐up was 5 to 19 months, with an average follow‐up of 14.6 months. There was only one complication among our 7 patients: a patient with a BMI of 38 developed a post‐surgical abdominal wound treated with local wound care. Otherwise, post‐operative courses were uneventful, and no further complications were reported.ConclusionWe demonstrate here additional evidence to the growing body of literature of the versatility and safety of the omentum to be utilized as an independent tool for surgical treatment of lymphedema as well as its simultaneous use with autologous breast reconstruction.

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Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

Cited by 8 publications

References 38 publications

The Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity

The Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity

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

Concurrent management of lymphedema and breast reconstruction with single‐stage omental vascularized lymph node transfer and autologous breast reconstruction: A case series

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