New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

Abstract

Summary:Lymphedema is a chronic debilitating disease, affecting a considerable part of the population; it results from impairment of the lymphatic system. It is highly prevalent among patients subjected to axillary and groin nodal dissection after surgery for breast cancer, abdominopelvic surgery, and lymphadenectomy after melanoma surgery. Interestingly, among the surgical treatment options for lymphedema, groin lymph node transfer is gaining popularity; however, in some cases, dissection at this site can cause significant morbidity, including possible development of iatrogenic lymphedema. To avoid these complications, new donor nodal groups are being proposed (eg, submental or supraclavicular). We have used the greater omentum as a lymph node and lymph vessel donor site. Dissection of the omentum is easy to perform and can even be done in patients who have undergone previous abdominal surgeries. We present refinements in the surgical technique for free omentum transfer in the management of secondary lymphedema: the first free omental flap dissection performed laparoscopically and the use of a primary flap as the recipient pedicle of a free greater omentum flap for anatomical repair after chest osteoradionecrosis and simultaneous functional repair of chronic lymphedema.

Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema

“…This approach resulted in an iatrogenic hernia, which led to some severe complications, and limited widespread adoption of this technique . The advent of microsurgery has reignited interest in the omentum flap, as this approach would allow transplantation to virtually anywhere in the body, and the abdomen to be closed completely . Although laparoscopic harvest of the omentum has also been described, in our experience open harvest through a limited incision is more precise and remains the preferred approach.…”

“…Vascularized omentum lymphatic transplant (VOLT) is a promising technique in the surgical treatment of lymphedema . The omentum contains an abundant supply of lymphatic tissue over a large surface area, making it a viable option for lymphatic reconstruction, especially for patients who have limited peripheral donor site options because of prior surgery, and radiation.…”

The Lymphatic System in Disease Processes and Cancer Progression

“…In the case of vascularized lymph node transfer, there can be a significant risk of regional lymphedema from the site where the donor lymph node was removed, depending on the donor site (174). Therefore, more recent studies have improved the process of omental lymph node flap harvesting (211, 212). Interestingly, Alitalo and colleagues (213) have shown that lymph node transfer in mice and pigs, when combined with perinodal VEGF-C therapy, induces lymphangiogenesis and improves lymphatic vessel function.…”

Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes

“…Previous studies using the GOLF reported an improvement in circumferential difference from 2% to 29%, circumferential reduction rate between 9% and 22.2% for upper extremity lymphedema, and from 50% to 75% for lower extremity lymphedema . Recently, Nguyen et al reported the long‐term outcome of 42 patients who underwent GOLF with a mean improvement in volumetric difference of 22% and good subjective improvements .…”