Complications after vascularized jejunal mesenteric lymph node transfer: A 3‐year experience

Abstract

Background: Vascularized lymph node transfer (VLNT) is a well-established method for the surgical management of refractory extremity lymphedema. Generally, donor lymph nodes are harvested from the axilla, groin, or supraclavicular area. However, these sites offer their own disadvantages and introduce risk for inducing lymphedema at the surgical donor site. In our experience, the jejunal mesentery can be an excellent source of lymph nodes without the risk of donor site lymphedema. Long term complications are unknown for this procedure; we report our experience, complication rates, and lessons learned. Methods: A retrospective review was performed for all patients at our institution undergoing surgical treatment of lymphedema using jejunal mesenteric VLNT from February 2015 to February 2018. Demographic data, length of follow up, and surgical complications were reviewed. Results: Twenty-nine patients have undergone jejunal VLNT at our institution during the three-year study period, with a total of 30 transfers. Five patients had a concurrent omental lymph node transfer. Average length of follow up was 17.6 months (range 1.0-36.8 months). There was one flap loss in this time frame (3.3%). Four patients developed hernias post-operatively (13.8%), and three had nonoperative small bowel obstructions (10.3%). One patient had a postoperative wound infection at the abdominal incision (3.4%). Conclusions: Jejunal VLNT can be an effective option for surgical treatment of lymphedema, without the risk of postoperative donor site lymphedema. Patients and surgeons should be aware of the risks of hernia and small bowel obstruction with this method compared to other lymph node sources.

Chimeric thoracodorsal lymph node flap with a perforator‐based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report

“…Twelve out of 15 patients had subjective improvement (87.5%) and the majority of patients with had objective improvement in lymphedema (Coriddi, Wee, et al, 2017). However, the surgeon has to take the risks of hernia and small bowel obstruction with this method into consideration (Kraft, Eiferman, Jordan, & Skoracki, 2019). The classical donor sites still constitute the fundament.…”

“…Clinical assessment revealed deep scar tissue in the lower leg, expecting to result in large wound dehiscence after scar release and pocket forma- (Coriddi, Wee, et al, 2017). However, the surgeon has to take the risks of hernia and small bowel obstruction with this method into consideration (Kraft, Eiferman, Jordan, & Skoracki, 2019). The classical donor sites still constitute the fundament.…”

Intra‐abdominal vascularized lymph node transfer for treatment of lymphedema: A systematic literature review and meta‐analysis

“…Three hundred and fifty-one studies were retrieved in the database after removal of duplicates, 291 of which were excluded after title/ abstract screening. Of the remaining publications, 21 were eligible for analysis (Figure 1) Ciudad et al, 2020;Ciudad, Manrique, Adabi, et al, 2019;Ciudad, Manrique, Date, Agko, et al, 2017;Ciudad, Manrique, Date, Sacak, et al, 2017;Ciudad, Maruccia, Socas, Lee, et al, 2017;Coriddi et al, 2017;Di Taranto et al, 2020;Di Taranto et al, 2021;Frey et al, 2020;Johnson et al, 2019;Kaya et al, 2020;Kenworthy et al, 2018;Kraft et al, 2019;Manrique, Bustos, Kapoor, et al, 2020;Manrique, Bustos, Kuruoglu, et al, 2020;Maruccia, Pezzolla, et al, 2019;Mousavi et al, 2020;Nguyen et al, 2017). There was 1 non-randomized controlled trial, 3 retrospective cohort studies, 5 prospective case series, and 12 retrospective case series.…”

“…All studies described the harvest of flap in either open or laparoscopic fashion. In total, 65 free omental VLN flaps (Di Taranto et al, 2020;Johnson et al, 2019;Kraft et al, 2019;Nguyen et al, 2017) and 362 free gastroepiploic VLN flaps were harvested Ciudad et al, 2020;Ciudad, Manrique, Date, Sacak, et al, 2017;Ciudad, Maruccia, Socas, Lee, et al, 2017;Kenworthy et al, 2018;Mousavi et al, 2020). One hundred and twenty-six free double omental/gastroepiploic VLN flaps Ciudad, Manrique, Adabi, et al, 2019;Ciudad, Manrique, Date, Agko, et al, 2017;Di Taranto et al, 2021;Frey et al, 2020;Kaya et al, 2020;Maruccia, Pezzolla, et al, 2019) and one free triple omental/gastroepiploic VLN flap (Kaya et al, 2020) were harvested, which involved splitting the flap into two or three lymph node flaps equally and transplanting them to multiple recipient sites to better improve the surgical outcome.…”

“…With the emergence of laparoscopy, such risks are better controlled. In addition to the omental VLN flap, there have been reports about other intra-abdominal flaps such as jejunal, ileocecal, and appendicular VLN flaps (Ciudad et al, 2018;Coriddi et al, 2017;Kraft et al, 2019).…”