Vascularized Lymph Node Transfer to the Ankle Improves Outcomes in Lower Limb Lymphedema Treatment Compared to Inset at the Knee

INTRODUCTION

Lower limb lymphedema is a debilitating condition conferring lifelong morbidity to patients. The mechanism of action of vascularized lymph node transfer is a principally by the pumping mechanism, which itself is dependant on the catchment of lymph under the effect of gravity.

 

This study evaluated whether distal placement of vascularized lymphatic flaps for lower limb lymphedema, at the ankle, maximising the lymphatic pump mechanism, was superior to placement at the knee.

 

MATERIALS AND METHODS

43 patients were enrolled in the study with lymphedema Cheng’s grade 2-4. Vascularized submental lymph node flaps were implanted at the knee or ankle respectively. Patients were analysed for grade of lymphedema, numbers of episodes of cellulitis and measurements of limb circumference. 

 

RESULTS

The proximal leg was used in 12 cases and the distal leg in 31 cases. There was no difference in patient demographics between the two groups. At three months the circumferential reduction rate was improved at the below knee and above ankle level in the distal placement group (p=0.01 and p=0.01), but improved in the proximal leg in the proximal placement group (p=0.01). At one year post operatively there was equal improvement in the above knee region (p=0.04) but there was significantly higher improvement in the distally placed group in the below knee, above ankle, and overall measurements (p=0.01, p=0.01, p=0.01 respectively). Lymphedema grade was improved in both groups but significantly more in the distally placed group. Episodes of cellulitis were reduced globally.

 

CONCLUSIONS

Distal placement of vascularized lymph node transfer gives a long term overall improvement in treatment of lower limb lymphedema. The dependant position increases the pump / catchment effect.