The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer

Steinbacher, Johannes; Tinhofer, Ines; Meng, Stefan; Reissig, Lukas F.; Placheta, Eva; Roka‐Palkovits, Julia; Rath, Thomas; Cheng, Ming‐Huei; Weninger, Wolfgang J.; Tzou, Chieh‐Han John

doi:10.1002/jso.24346

Cited by 30 publications

(19 citation statements)

References 14 publications

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“…In contrast, Gerety et al counted around 1.8 gross lymph nodes at the thoracodorsal donor site. 28 Similar lymph node counts of other donor sites have been reported, [29][30][31][32] whereas our study revealed a much higher number of lymph nodes. Differences in lymph node quantity of our study compared to others may be attributed to our dissection under 2.5 times loop magnification.…”

Section: Perfusion Studysupporting

confidence: 90%

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

Tinhofer

Meng

Steinbacher

et al. 2017

Journal of Surgical Oncology

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Section: Perfusion Studysupporting

confidence: 90%

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

Tinhofer

Meng

Steinbacher

et al. 2017

Journal of Surgical Oncology

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“…Vascularized lymph node transfer has emerged as a relatively new physiologic procedure that brings functional lymph nodes into the affected site and restores lymphatic flow (Becker, Assouad, Riquet, & Hidden, ). Common donor sites for vascularized lymph node transfer include the inguinal (Becker et al, ; Clodius, Smith, Bruna, & Serafin, ; Gharb et al, ; Lin et al, ), axillary (Dayan, Dayan, & Smith, ), submental (Cheng et al, ; Patel et al, ), supraclavicular (Althubaiti, Crosby, & Chang, ; Steinbacher et al, ), and lateral thoracic (Batista, Germain, Faria, & Becker, ; Becker et al, ) regions. However, donor site morbidity remains a concern, including iatrogenic lymphedema, lymphorrhea, nerve injury, and conspicuous scar (Ciudad et al, ; Pappalardo, Patel, & Cheng, ; Patel et al, ; Sulo et al, ; Viitanen, Maki, Seppanen, Suominen, & Saaristo, ).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of pedicled vascularized inguinal lymph node transfer in a mouse model: A preliminary study

et al. 2018

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Purpose: Vascularized lymph node transfer is becoming more common in the treatment of lymphedema, but suitable small animal models for research are lacking. Here, we evaluated the feasibility of pedicled vascularized inguinal lymph node transfer in mice.Methods: Twenty-five mice were used in the study. An inguinal lymph node-bearing flap with a vascular pedicle containing the superficial caudal epigastric vessels was transferred into the ipsilateral popliteal fossa after excision of the popliteal lymph node. Indocyanine green (ICG) angiography was used to confirm vascularity of the flap. ICG lymphography was performed to evaluate lymphatic flow at 3 and 4 weeks postoperatively. Patent blue dye was injected into the ipsilateral hind paw to observe staining of the transferred lymph node at 4 weeks postoperatively. All transferred lymph nodes were then harvested and histologically evaluated by hematoxylin and eosin staining.Results: In 16 of the 25 mice, ICG lymphography showed reconnection between the transferred lymph node and the afferent lymphatic vessels, as confirmed by patent blue staining. Histologically, these transferred lymph nodes with afferent lymphatic reconnection significantly regressed in size (0.37 AE 0.24 mm 2 ) and showed clear follicle formation, whereas those without afferent lymphatic reconnection showed less size regression (1.31 AE 1.17 mm 2 ); the cell population was too dense to allow identification of follicles. Conclusions:We established a mouse model of vascularized lymph node transfer with predictable afferent lymphatic reconnection. Both the vascularization and reconnection might be necessary for functional regeneration of the transferred lymph node.

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“…Injury to this nerve can lead to asymmetries in facial movement, which are noticeable on opening the mouth, smiling, or grimacing. 46,47 In fact, Cheng et al report finding subtle asymmetries in $10% of patients in the early postoperative period following use of the submental VLN flap, although all cases resolve on their own without permanent nerve injury. 45 Furthermore, the pedicle length is short, which may require the inclusion of the facial vessels.…”

Section: Submental Flapmentioning

confidence: 99%

Vascularized Lymph Node Transfer for Lymphedema

Schaverien

Badash

Patel

et al. 2018

Seminars in Plastic Surgery

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120

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Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.

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The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer

Abstract: The pedicle length and diameter of the supraclavicular lymph node flap are suitable for a microvascular tissue transfer. J. Surg. Oncol. 2017;115:60-62. © 2016 Wiley Periodicals, Inc.

Cited by 30 publications

References 14 publications

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

Feasibility of pedicled vascularized inguinal lymph node transfer in a mouse model: A preliminary study

Vascularized Lymph Node Transfer for Lymphedema

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