Intra-abdominal donors for vascularized lymph node transfer: an update and review

Danforth, Rachel; Skoracki, Roman J.

doi:10.20517/2347-9264.2021.34

Cited by 4 publications

(11 citation statements)

References 20 publications

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“…Omentum is the most often used intra-abdominal flap. 30 It is potentially an ideal donor candidate because of its high degree of vascularization, large in size, vast lymphatic channels, and lymphatic lakes. 30,31 Our study revealed that VLNT interventions resulted in substantial CRR of the upper limb.…”

Section: Limb Circumference Reduction Rate and Postoperative Infectio...mentioning

confidence: 99%

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb

Braizat,

Jarrar,

El-Debs

et al. 2024

Ann Plast Surg

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Background Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites. Methods We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies. Results A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7–41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36–0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection. Conclusions Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.

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Section: Limb Circumference Reduction Rate and Postoperative Infectio...mentioning

confidence: 99%

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb

Braizat,

Jarrar,

El-Debs

et al. 2024

Ann Plast Surg

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“…In recent years, additional donor sites for lymphatic tissue have been found. There are several benefits to obtaining lymph nodes and tissue from the abdominal cavity, as it can mitigate the risk for donor-site lymphedema-a major concern when it comes to VLNTs from extra-abdominal sites [48] . Intra-abdominal sites also allow for the ability to harvest up to 3 vascularized flaps from 1 donor site [48] .…”

Section: Intra-abdominal Vs Extra-abdominalmentioning

confidence: 99%

“…There are several benefits to obtaining lymph nodes and tissue from the abdominal cavity, as it can mitigate the risk for donor-site lymphedema-a major concern when it comes to VLNTs from extra-abdominal sites [48] . Intra-abdominal sites also allow for the ability to harvest up to 3 vascularized flaps from 1 donor site [48] . With the possibility of laparoscopic harvest, the risk of donor-site morbidity may be reduced and minimal donor-site scars can be well-hidden [48,49] .…”

Section: Intra-abdominal Vs Extra-abdominalmentioning

confidence: 99%

“…Intra-abdominal sites also allow for the ability to harvest up to 3 vascularized flaps from 1 donor site [48] . With the possibility of laparoscopic harvest, the risk of donor-site morbidity may be reduced and minimal donor-site scars can be well-hidden [48,49] .…”

Section: Intra-abdominal Vs Extra-abdominalmentioning

confidence: 99%

“…The most common intra-abdominal flap is derived from the omentum [49] . The omentum is highly vascularized and large in size, with large lymphatic channels, and lymphatic lakes, which make it a potentially ideal donor site candidate [48][49][50] . While VLNTs from other intra-abdominal donor sites like the ileocecum and appendix are being explored, currently, there is limited data on the efficacy and safety of these specific flaps.…”

Section: Intra-abdominal Vs Extra-abdominalmentioning

confidence: 99%

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Vascularized lymph node transfer for the treatment of lymphedema: a systematic review and meta-analysis of clinical and patient-reported outcomes

Raman¹,

Sanka²,

Ji³

et al. 2023

Plast Aesthet Res

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Aim: The aim of this systematic review was to summarize clinical and patient-reported outcomes (PROs) for various vascularized lymph node transfer (VLNT) donor sites and identify gaps in the literature to guide future research. Methods: A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021. Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included. Results: Sixty-six studies met the study criteria. Most studies reported improved limb circumference/volume, reduction or discontinuation of conservative therapy, infection rate reduction, improved PROs, or postoperative imaging findings reflecting functional lymph nodes. There were significantly lower infection rates (P < 0.05) and a trend towards improved PROs in patients who received intra-abdominal flaps, but overall few studies reported these outcomes. There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites, or between intra-abdominal vs. extra-abdominal VLNT donor sites, although these outcomes are not uniformly reported. Conclusion: This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites. Though recent investigations address many understudied VLNT donor sites, larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes, which can offer more concrete evidence to guide surgical practice.

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Lymphatic System – Surgeon’s Point of View

Almeida¹,

Ofir²,

Zeltzer³

2023

Preprint

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Lymphedema is a chronic and debilitating disease that affects up to 250 million patients worldwide. Recent advances in understanding its pathophysiology, along with improved diagnosis and microsurgical techniques, have enhanced our ability to cope with the challenging task of treating this disease. This review provides an overview of the disease from a surgeon's point of view, including existing imaging modalities used for preoperative assessment, as well as surgical procedures used in its treatment. Advantages and drawbacks of various existing modalities used for pre or intraoperative assessment of lymphatic vessels are discussed. Lymphedema treatment has shifted from palliative debulking procedures (liposuction and direct excision) to those aimed at restoring lymphatic flow and countering the pathophysiology of the disease (lymphaticovenous anastomosis and vascularized lymph node transfer). A combination of both approaches can result in a synergistic benefit for patients and are discussed in this review. Despite recent advances, some controversies persist, and further studies are needed to better define surgical treatment algorithms.

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Intra-abdominal donors for vascularized lymph node transfer: an update and review

Cited by 4 publications

References 20 publications

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb

Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb

Vascularized lymph node transfer for the treatment of lymphedema: a systematic review and meta-analysis of clinical and patient-reported outcomes

Lymphatic System – Surgeon’s Point of View

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