Abstract
Lower limb lymphedema is a significant debilitating condition requiring a multidisciplinary approach in its management. Recent advances in microsurgical techniques have allowed an increase in surgical treatment options that can be offered to patients. Vascularized lymph node transfer (VLNT) involves the transfer of functional lymph nodes by vascular microanastomosis to the recipient bed to restore lymphatic flow to an area of the body where the native lymph nodes are not present or are removed. Besides measurable improvements in edema, the literature reflects improvements in quality of life when VLNT is performed for lymphedema in general. As such, knowledge of VLNT is essential for any microsurgeon offering patients lymphedema treatment. This includes appreciating and mastering the possible donor sites that can be used for VLNT.
The lateral thoracic fasciocutaneous flap for soft tissue reconstruction was described in the 1970s, however it did not gain widespread popularity due to the anatomic variations in the origin and presence of the vascular pedicle. Nonetheless, the advent of VLNT and the presence of lymph nodes in the axillary area led to the use of the lateral thoracic axillary lymph nodes (LTLN) as a donor site by Trevidic and Cormier in the 1990s. Since then, the uptake of the LTLN has been slow. Recent advances in anatomical knowledge and technical know-how have now allowed surgeons to approach the LTLN flap with increased confidence and safety. This chapter provides a case and a step-by-step approach on how to approach LTLN flap reconstruction for VLNT.
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Kapila, A.K., Zeltzer, A.A. (2022). Lateral Thoracic Artery Lymph Nodes (LTLN) for Lower Limb Lymphedema. In: Gravvanis, A., Kakagia, D.D., Ramakrishnan, V. (eds) Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-23706-6_111
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