Delayed primary retention suture for inset of vascularized submental lymph node flap for lower extremity lymphedema

Abstract

BackgroundVascularized lymph node transfer (VLNT) has become one of the effective surgical treatments for extremity lymphedema. This study was to evaluate the re‐exploration and total complication rates of VLNT for lower extremity lymphedema between two different flap inset techniques.MethodsSixty‐nine patients who underwent 74 submental VLNT transfers between 2008 and 2018 were retrospectively studied. Fifty‐six flaps were inset using a new delayed primary retention suture (DPRS) technique and other 18 flaps using conventional interrupted sutures as the non‐DPRS group.ResultsThe overall flap success rate was 100%. The DPRS group was released at a mean of 1.7 ± 0.7 times and took a mean of 10.3 ± 3.3 days for wound closure. There were no statistical differences in demographics, mean symptom duration, and mean Cheng's Lymphedema Grading between two groups. Mean frequency of cellulitis of 2.5 ± 1.5 times/year in non‐DPRS group was significantly greater than 1.4 ± 1.6 times/year in DPRS group (P = .01). The re‐exploration and total complication rates were 5.4% and 7.1% in DPRS group, and 27.8% and 33.3% in non‐DPRS group, respectively (P = .02 and .02, respectively).ConclusionsThe DPRS technique is a safe, simple, and reliable method for insetting the submental VLNT, which statistically decreased the re‐exploration and total complication rates.

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity

“…Thirty-nine studies reporting surgical complications of VLNT were identified (see Supplementary Table S2 [available in the online version], which displays an overview of the included studies). 13 22 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 The most common complications detailed after groin VLNT were donor site pain or numbness ( n = 32, 26.8%), delayed wound healing ( n = 16, 13.44%), seroma formation ( n = 14, 11.76%), lymphatic fluid leakage ( n = 12, 10.08%), venous congestion ( n = 9, 7.56%), and iatrogenic lymphedema ( n = 5, 4.2%). When using lateral thoracic VLNT, iatrogenic lymphedema ( n = 4, 30.76%), cellulitis ( n = 2, 15.38%), and seroma and hematoma formation ( n = 2, 15.38%) were also commonly reported.…”

Nipple‐sparing mastectomy with immediate breast reconstruction with a deep inferior epigastric perforator flap without skin paddle using delayed primary retention suture

“…The BREAST‐Q questionnaire, including four domains of Psychosocial well‐being, Sexual well‐being, Satisfaction with breasts, and Physical well‐being: Chest, was used to evaluate the patient‐reported outcome was obtained from patients before surgery and at the last clinical visit. The Manchester scar scale, a multi‐item categorical scale including visual analog scale (VAS), with global scar assessment, was used to assess scars between both groups 21 …”

“…It has a potential patient‐perceived psychological impact on their reconstructive journey. Koide et al 21 addressed a “delayed primary retention sutures (DPRS)” technique for the inset of vascularized lymph node flap transfer to the distal recipient site for extremity lymphedema. The purpose of this study was to investigate the complications and outcomes of NSM with breast reconstruction with a DIEP flap using the DPRS technique for flap monitoring, to improve the cosmesis of the reconstructive breast mound.…”

“…The Manchester scar scale, a multi-item categorical scale including visual analog scale (VAS), with global scar assessment, was used to assess scars between both groups. 21 Seven plastic surgeons and fellows assessed the Manchester scar scale as observers at a mean 12 months of follow-up. The lower the Manchester scar scale, the better the cosmetic appearance of the scars.…”

Distal facial vein catheterization for prevention and management of thrombosis in vascularized lymph node transfers

“…VSLN flap transplantation was indicated if patients met the following criteria: 1) Cheng's Lymphedema Grades II–IV, 2) total occlusion on Taiwan lymphoscintigraphy staging system, 3) partial occlusion on Taiwan lymphoscintigraphy staging system with no patent lymphatic vessels detected with indocyanine green lymphography, 4) poor response to 6 months of complete decongestive therapy, and 5) repeated episodes of cellulitis. Recent refinements have been added to the surgical technique, aiming to decrease the risk of venous congestion and thrombosis 13 . Since March 2017, the DPRS was routinely applied to the VSLN flap transplantation to release the flap swelling and adjust the tension of the sutures, which reduced the complication rate from 33.3% to 7.1% 13 .…”