“Anatomic Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomography Angiography (CTA)”

PURPOSE: The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer (VLNT). The anatomy of the gastroepiploic vessels, omentum, and lymph nodes (LN) has not been investigated. The purpose of this study is to describe the right gastroepiploic artery (GEA) and related structures by using computed tomography angiography (CTA). MATERIALS AND METHODS: A retrospective analysis was conducted on 34 patients who received CTA. Statistical models were applied to identify right GEA and LN anatomical characteristics. RESULTS: The right GEA was identified in 33 of 34 patients. It was found to have a diameter of 2.49mm at its origin (SD 0.66). The gastroduodenal artery length prior to right GEA takeoff was 3.09cm (SD 1.31). Twenty-five patients had lymph nodes in the right GEA lymphosome. There were 2.7 LNs identified per patient (SD 2.12). The distance from the right GEA origin to the most proximal LN was 3.99cm (SD 2.21). The distance from the GEA origin to the third LN was 9.12cm (SD 5.06). Each LN was within 7.00mm (SD 6.2) of the right GEA. CONCLUSIONS: When using the right GEA donor site for VLNT, the plastic surgeon should anticipate using a pedicle length of 4cm, a total flap length of 9cm with 3cm of surrounding tissue in order to obtain at least 3 lymph nodes for transfer. CTA is an effective imaging modality that can be used for patient-specific surgical navigation prior to vascularized lymph node transfer. Financial Disclosure Statement: Ketan Patel is a consultant for Novadaq Corp and receives textbook royalties from Elsevier Corp. All other authors have no disclosures. Corresponding Author: Ketan M. Patel, M.D., Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, ketan.patel@med.usc.edu ©2018American Society of Plastic Surgeons