Abstract
Vascularized lymph node transfer is an emerging method of lymphatic reconstruction in the surgical management of lymphedema. The cervical region is a useful donor site because of the abundance of lymph nodes. The clinical approach to a 67-year-old patient who presented with secondary lower extremity lymphedema and cellulitis after pelvic surgery is described. She underwent vascularized lymph node transfer from her submandibular region to the groin and liposuction of her legs and outer thigh. Perometry 2-years postoperatively showed 44% reduction in volume from 14,243 to 7938 ml. She had no further episodes of cellulitis in the 3 years of follow up.
The lymph node flap harvesting technique emphasizes visualization of the hilar arterioles and venules supplying the submandibular lymph nodes and delineating their connections to named pedicles in the neck. The submandibular lymph nodes are supplied by the facial artery and its branches, namely, the facial branch and the submental branch. Based on location, they are classified as superficial, deep, and submental. The venous drainage of cervical lymph nodes is variable, and the veins do not necessarily run in parallel with the arteries. Submandibular lymph nodes drain into the facial vein, the external jugular or anterior jugular veins. The surgical technique utilizes an upper cervical skin crease incision and a stepwise approach to locating lymph nodes. A delicate technique which is demonstrated in our surgical video is emphasized (video). Indocyanine green angiography is used to confirm the vascularity of the flap. In the lower extremity, vascularized lymph nodes are transferred to the groin or medial leg, utilizing matching recipient vessels.
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Tan, BK., Hsieh, M., Onishi, F. (2022). Free Transfer of Cervical Lymph Nodes to a 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_118
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DOI: https://doi.org/10.1007/978-3-030-23706-6_118
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