Michelle Coriddi1, Corrine Wee1, Joseph Meyerson1, Daniel Eiferman2, Roman Skoracki3. 1. Department of Plastic Surgery, The Ohio State University, Columbus, OH. 2. Department of General Surgery, The Ohio State University, Columbus, OH. 3. Department of Plastic Surgery, The Ohio State University, Columbus, OH. Electronic address: roman.skoracki@osumc.edu.
Abstract
BACKGROUND: Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT. STUDY DESIGN: We performed a cadaveric anatomic study analyzing jejunal lymph nodes (LNs) and describe outcomes from the first patients who received jejunal mesenteric VLNT for treatment of lymphedema. RESULTS: In 5 cadavers, the average numbers of total LNs and peripheral LNs were identified in the proximal, middle, and distal segments of jejunum. Totals counted were 19.2/13.8/9.6, (SD 7.0/4.4/1.1), respectively; of those, 10.4/6.8/3.4 (SD 3.6/2.3/2.6), respectively, were in the periphery. There were significantly more total and peripheral lymph nodes in the proximal segment compared with the middle and distal segments (p = 0.027 and p = 0.008, respectively). The jejunal VLNT was used in 15 patients for treatment of upper (n = 8) or lower (n = 7) extremity lymphedema. Average follow-up was 9.1 (±6.4) months (range 1 to 19 months). Of 14 patients with viable flaps (93.3%), 12 had subjective improvement (87.5%). Ten patients had preoperative measurements, and of those, 7 had objective improvement in lymphedema (70%). CONCLUSIONS: The jejunal mesenteric VLNT is an excellent option for lymphedema treatment because there is no risk of donor site lymphedema or nerve damage, and the scar is easily concealed. Harvest from the periphery of the proximal jejunum is optimal. Improvement from lymphedema can be expected in a majority of patients.
BACKGROUND: Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT. STUDY DESIGN: We performed a cadaveric anatomic study analyzing jejunal lymph nodes (LNs) and describe outcomes from the first patients who received jejunal mesenteric VLNT for treatment of lymphedema. RESULTS: In 5 cadavers, the average numbers of total LNs and peripheral LNs were identified in the proximal, middle, and distal segments of jejunum. Totals counted were 19.2/13.8/9.6, (SD 7.0/4.4/1.1), respectively; of those, 10.4/6.8/3.4 (SD 3.6/2.3/2.6), respectively, were in the periphery. There were significantly more total and peripheral lymph nodes in the proximal segment compared with the middle and distal segments (p = 0.027 and p = 0.008, respectively). The jejunal VLNT was used in 15 patients for treatment of upper (n = 8) or lower (n = 7) extremity lymphedema. Average follow-up was 9.1 (±6.4) months (range 1 to 19 months). Of 14 patients with viable flaps (93.3%), 12 had subjective improvement (87.5%). Ten patients had preoperative measurements, and of those, 7 had objective improvement in lymphedema (70%). CONCLUSIONS: The jejunal mesenteric VLNT is an excellent option for lymphedema treatment because there is no risk of donor site lymphedema or nerve damage, and the scar is easily concealed. Harvest from the periphery of the proximal jejunum is optimal. Improvement from lymphedema can be expected in a majority of patients.
Authors: Nadeem R Abu-Rustum; Roberto Angioli; Arthur E Bailey; Vance Broach; Alessandro Buda; Michelle R Coriddi; Joseph H Dayan; Michael Frumovitz; Yong Man Kim; Rainer Kimmig; Mario M Leitao; Mustafa Zelal Muallem; Matt McKittrick; Babak Mehrara; Roberto Montera; Lea A Moukarzel; Raj Naik; Silvana Pedra Nobre; Marie Plante; Francesco Plotti; Oliver Zivanovic Journal: Int J Gynecol Cancer Date: 2020-03-30 Impact factor: 3.437
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: Carrie K Chu; Mark V Schaverien; Edward I Chang; Summer E Hanson; Matthew M Hanasono; Jesse C Selber Journal: Plast Reconstr Surg Glob Open Date: 2020-03-27
Authors: Edward I Chang; Carrie K Chu; Summer E Hanson; Jesse C Selber; Matthew M Hanasono; Mark V Schaverien Journal: Plast Reconstr Surg Glob Open Date: 2020-03-27