Vascularized lymph node flap transfer (VLNFT) is a tissue transfer procedure of high interest for the treatment of lymphedema. VLNFT is a new approach for treating lymphedema and during the last few years it is becoming more popular. 1 Different donor sites for VLNFT including groin, supraclavicular, submental, thoracodorsal artery have been described.Herein, we present the results of the successful surgical management of six patients suffering from upper (2) and lower (4) limb lymphedema using a novel vascularized lymph node flap based on the right gastroepiploic (R-GE) vessels. To our knowledge, this is the first report using an intra-abdominal lymph node flap to treat lymphedema.The flap was based on the R-GE artery and vein. Harvest of the flap was performed through an upper midline laparotomy incision. The first step was to identify the right gastroepiploic vessels, then omentum was carefully dissected off the transverse colon with great care not to injure the mesocolon. The left gastroepiploic vessels were then divided and dissection of the short segmental gastric branches allowed the release of the flap from the stomach and permitted complete visualization of the R-GE vessels. Dissection was carried to the level of the right epiploic vessels. The lymph nodes within the flap cannot always be visualized but they often can be palpable. Indocyanine green lymphatic imaging could be performed to confirm the vascularity of the lymph nodes included within the flap.All patients underwent preoperative assessment, including photographs, circumference measurement, lymphoscin-tigraphy, and skin tonicity measurement. Microsurgical anastomoses were performed using the medial plantar vessels end-to-end and the radial artery for end-to-side anastomosis of lower and upper limb lymphedema respectively (Fig. 1). A suction drain was left in situ at the donor-site for 6 days. Patients were discharged on the tenth postoperative day. Post-operative follow-up was performed every 3 months during the first year.After 1 year follow-up all patients exhibited significant improvement and were satisfied with the functional and aesthetic results. Lymphoscintigraphy was performed and improvement was seen in all cases. No postoperative episodes of cellulitis or other complications were observed during the follow-up period.This flap has two mechanisms of function: one is the physiological lymphatic drainage from the interstitium to the vascularized lymph node flap and then into the pedicle vein, 2 and the second is through its ability to absorb the lymphatic fluid by the omentum tissue adjacent to the vascular pedicle. 3 Advantages of the use of this flap include the large diameter of the gastroepipolic vessels, minimal donor-site morbidity, no concern of causing iatrogenic lymphedema, and allowing a two-team approach. This flap contains omentum tissue around the pedicle that will also help in the absorption of lymphatic fluid by the affected limb. The use of laparoscopy to harvest the flap could offer a minimal insult to the abdominal wall ...

With appropriate patient selection and surgical technique the TUGPAP flap could be a valuable option as an alternative method for autologous breast reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

Background The pathophysiology of hypertrophic scarring is unknown due in part to the lack of a robust animal model. Although the red Duroc pig has emerged as a promising in vivo model, the cellular mechanisms underlying Duroc scarring are unknown, and the size and cost of Duroc pigs are obstacles to their use. Given the central role of the dermal fibroblast in scarring, we hypothesized that dermal fibroblasts from the Duroc pig exhibit intrinsic differences in key aspects of the fibroblast response to injury compared to those from the Yorkshire pig, a same-species control that heals normally. Methods Duroc and Yorkshire dermal fibroblasts were isolated from uninjured dorsal skin. Actin stress-fibers and focal adhesions were visualized by immunocytochemistry and transmission electron microscopy. Cell migration was measured using a scratch wound-closure assay. Contractile function was assessed by collagen-gel contraction. Expression of scarring-related genes was determined by quantitative RT-PCR, and transforming growth factor beta 1 (TGF-B1) protein expression was determined by Western blotting. Results Duroc dermal fibroblasts display increased adhesion-complex formation, impaired migration, enhanced collagen contraction, and pro-fibrotic gene- and protein-expression profiles compared to Yorkshire fibroblasts at baseline. In addition, Duroc fibroblasts over-expressed TGF-β1 and were less responsive to exogenous TGF-β1. Conclusions Duroc dermal fibroblasts have inherent myofibroblastic differentiation that may account for the pathologic scarring in these animals. Our data further validate the Duroc model and support Duroc fibroblast cell culture as a simple, inexpensive, reproducible, and biologically tractable in vitro model for the study of fibroproliferative scarring.