The laparoscopic right gastroepiploic lymph node flap transfer for upper and lower limb lymphedema: Technique and outcomes
Journal
Microsurgery
Journal Volume
37
Journal Issue
3
Pages
197-205
Date Issued
2017
Author(s)
Ciudad P.
Maruccia M.
Socas J.
Lee M.-H.
Constantinescu T.
Kiranantawat K.
Nicoli F.
Sapountzis S.
Yeo M.S.-W.
Chen H.-C.
Abstract
Background: Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema. Methods: From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II–III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and Lymphedema Quality of Life (LYMQOL) questionnaire. Clinical and CT evaluation of donor-site morbidity were performed. Results: The flap survival rate was 100%, with a mean harvest time of 32 minutes and total operating time of 164 minutes. One case required regrafting for skin graft loss. The mean limb reduction rate was 39.5% at a mean follow-up of 14.7 months. Perioperative lymphoscintigraphy demonstrated transferred lymph node viability and lymphatic transport improvement. LYMQOL showed a 2.6-fold quality-of-life improvement (P < 0.01). No donor-site morbidity was encountered. Conclusions: The use of the laparoscopically harvested right gastroepiploic lymph node flap may be a safe technique that improves limb measurements and quality of life in extremity lymphedema patients. ? 2015 Wiley Periodicals, Inc. Microsurgery 37:197–205, 2017. ? 2015 Wiley Periodicals, Inc.
SDGs
Other Subjects
adult; Article; breast cancer-related lymphedema; clinical article; clinical evaluation; conservative treatment; female; human; laparoscopic surgery; lower limb pelvic cancer related lymphedema; lymphedema; lymphoscintigraphy; middle aged; morbidity; operation duration; perioperative period; priority journal; quality of life; questionnaire; right gastroepiploic lymph node flap transfer; skin graft; surgical technique; treatment outcome; x-ray computed tomography; aged; cohort analysis; diagnostic imaging; free tissue graft; gastroepiploic artery; graft rejection; graft survival; laparoscopy; lower limb; lymph node; lymphedema; microsurgery; pathophysiology; procedures; prognosis; quality of life; retrospective study; risk assessment; transplantation; upper limb; vascularization; Adult; Aged; Cohort Studies; Female; Free Tissue Flaps; Gastroepiploic Artery; Graft Rejection; Graft Survival; Humans; Laparoscopy; Lower Extremity; Lymph Nodes; Lymphedema; Lymphoscintigraphy; Microsurgery; Middle Aged; Prognosis; Quality of Life; Retrospective Studies; Risk Assessment; Upper Extremity
Publisher
John Wiley and Sons Inc.
Type
journal article