Abstract: Laparoscopic Harvest of an Extended Right Gastroepiploic Lymph Node Flap with Double Level Inset in Patients with Extremity Lymphedema (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 10:40 AM

Pedro Ciudad, MD, PhD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Oscar J Manrique, MD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Ketan M Patel, MD , Plastic Surgery, University of Southern California, Los Angeles, CA

Mouchammed Agko, MD , Akademikliniken, Stockholm, Sweden

Federico Lo Torto, MD , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Hung-Chi Chen, MD, PhD, FACS , Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

Presentation PDF file

Background

Lymph node flap (LNF) transfer has shown promising results and its becoming one of the mainstay treatment options for extremity lymphedema. However, there are concerns regarding donor site morbidity following LNF harvest. Also, some observations have been made with regards of the effect of LNF on areas of the extremity away from the transferred flap. Herein, we describe the extended right gastroepiploic lymph node flap (RGE-LNF) via laparoscopic approach with a double level flap inset for patients with upper and lower limb lymphedema.

Methods

Between 2012 and 2015, patients with grade II and III upper or lower extremity lymphedema were selected for LNF transfer. Preoperative and postoperative limb circumference and lymphoscintigraphy were obtained. All patients underwent laparoscopic harvest of the extended RGE-LNF. In all cases, a double inset was performed at a distal and mid-limb level of the affected limb by dissecting a single flap in two. In addition, etiology of lymphedema, OR time and complications were analyzed.

Results

A total of 7 patients were analyzed. The etiology was due to mastectomy and axillary lymph node dissection for breast cancer (n=4) and after hysterectomy and radiotherapy for gynecological cancer (n=3). The survival rate of the flaps after microsurgical transfer was 100%. The average operating time for flap harvest was 37 ± 4.7 minutes; The average time for flap preparation was 8.7 ± 0.8 minutes. The average total operating time including harvest and insets was 245 minutes. The average follow-up period was 14 months. The mean circumference reduction rate of the lymphedematous limb during follow-up was 43.4 ± 4.0% (range, 38.3% to 48.9%). Postoperative lymphoscintigraphy showed improvement of the lymph flow on the affected limb in all cases. No donor-site morbidity was encountered during the follow-up period.

Conclusions

The laparoscopic harvest of the extended RGE-LNF with a double level flap inset has been showing promising results. Due to the reduction of overall limb volume and symptomatic improvement, this approach may be a new potential treatment option for patients with extremity lymphedema. In addition, minimally invasive approach achieved reduction in donor site morbidity.

30480 Laparoscopic Harvest of an Extended Right Gastroepiploic Lymph Node Flap with Double Level Inset in Patients with Extremity Lymphedema