Orthotopic transfer of vascularized groin lymph node flap in the treatment of breast cancer-related lymphedema: clinical results, lymphoscintigraphy findings and proposed mechanism

Publication date: Available online 28 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hin-Lun Liu, Suet-Ying Pang, Chung-Ching Lee, Melody Man-Kuen Wong, Hon-Ping Chung, Yu-Wai Chan
IntroductionVascularized lymph node transfer (VLNT) has become more popular in treating secondary lymphedema. However, the mechanism has not been clearly elucidated.The purpose of this study were (1) to evaluate the outcome of vascularized groin lymph node (VGLN) transfer using axilla as a recipient site in patients with breast cancer-related lymphedema (BCRL) and (2) to provide radiological evidence of lymphangiogenesis in VLNT.MethodsBetween August 2013 and June 2016, 30 consecutive patients with a mean age of 60 years underwent VGLN transfer for BCRL. A skinless VGLN flap nourished by the superficial circumflex iliac vessels was transferred to the axillary region of lymphedematous limb. The outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy.ResultsAt a mean follow-up of 22.11 ± 7.83 months, 21 (70%) patients had reduction in limb circumference. The mean circumference reduction rate of the lymphedematous limb was 47.06 ± 27.92% (range, 0 to 100%).Eleven (37%) patients showed radiological improvement in post-operative lymphoscintigraphy that included 7 cases of faster contrast transport and 4 cases of visualization of transplanted lymph node.ConclusionPatients with BCRL can benefit from orthotopic VGLN transfer. Lymphangiogenesis is supported by the visualization of transplanted lymph node in post-operative lymphoscintigraphy.