Pedro Ciudad1,2, Michele Maruccia1,3, Juan Socas4, Ming-Hsien Lee5, Kuo-Piao Chung6, Thomas Constantinescu1, Kidakorn Kiranantawat7, Fabio Nicoli1, Stamatis Sapountzis1, Matthew Sze-Wei Yeo, Hung-Chi Chen1. 1. Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan. 2. Tissue Engineering and Regenerative Medicine Program, Department of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan. 3. Department of Plastic, Reconstructive, and Aesthetic Surgery, "Sapienza" University, Rome, Italy. 4. Department of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN. 5. Department of General Surgery, China Medical University Hospital, Taichung, Taiwan. 6. Institute of Healthcare Policy and Management, Department of Public Health, National Taiwan University, Taipei, Taiwan. 7. Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Abstract
BACKGROUND: Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema. METHODS: From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II-III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and Lymphedema Quality of Life (LYMQOL) questionnaire. Clinical and CT evaluation of donor-site morbidity were performed. RESULTS: The flap survival rate was 100%, with a mean harvest time of 32 minutes and total operating time of 164 minutes. One case required regrafting for skin graft loss. The mean limb reduction rate was 39.5% at a mean follow-up of 14.7 months. Perioperative lymphoscintigraphy demonstrated transferred lymph node viability and lymphatic transport improvement. LYMQOL showed a 2.6-fold quality-of-life improvement (P < 0.01). No donor-site morbidity was encountered. CONCLUSIONS: The use of the laparoscopically harvested right gastroepiploic lymph node flap may be a safe technique that improves limb measurements and quality of life in extremity lymphedema patients.
BACKGROUND: Lymph node flap transfer popularity for treatment of extremity lymphedema is increasing quickly. Multiple flap donor sites were described in search of the optimal one. We describe the technique and outcomes of a laparoscopically harvested right gastroepiploic lymph node flap for treatment of extremity lymphedema. METHODS: From January 2012 to January 2013, 10 consecutive female patients, average age 54.8 years, with International Society of Lymphology stage II-III extremity lymphedema refractory to conservative management were included. Five patients had upper limb breast cancer-related lymphedema and five patients had lower limb pelvic cancer-related lymphedema. All patients underwent laparoscopic harvest of the right gastroepiploic lymph node flap, transferred to the wrist and ankle as recipient sites. Flaps were covered with a small skin graft taken from the thigh. Perioperative assessment included physical exam, photography, circumference measurements, CT scans, lymphoscintigraphy, and Lymphedema Quality of Life (LYMQOL) questionnaire. Clinical and CT evaluation of donor-site morbidity were performed. RESULTS: The flap survival rate was 100%, with a mean harvest time of 32 minutes and total operating time of 164 minutes. One case required regrafting for skin graft loss. The mean limb reduction rate was 39.5% at a mean follow-up of 14.7 months. Perioperative lymphoscintigraphy demonstrated transferred lymph node viability and lymphatic transport improvement. LYMQOL showed a 2.6-fold quality-of-life improvement (P < 0.01). No donor-site morbidity was encountered. CONCLUSIONS: The use of the laparoscopically harvested right gastroepiploic lymph node flap may be a safe technique that improves limb measurements and quality of life in extremity lymphedemapatients.
Authors: Oscar J Manrique; Samyd Said Bustos; Trishul Kapoor; Jason Lin; Pedro Ciudad; Antonio J Forte; Gabriel Del Corral; Maria Mani; Michele Maruccia; Andre Terzic Journal: Gland Surg Date: 2020-04
Authors: Pedro Ciudad; Antonio J Forte; Maria T Huayllani; Daniel Boczar; Oscar J Manrique; Samyd S Bustos; Atenas Bustamante; Hung-Chi Chen Journal: Gland Surg Date: 2020-04
Authors: Pedro Ciudad; Oscar J Manrique; Samyd S Bustos; Maria I Vargas; César Reynaga; Mouchammed Agko; Tony C T Huang; Eduardo Figueroa Benites; Horacio F Mayer; Antonio J Forte Journal: Gland Surg Date: 2020-04