Taoyuan, Taiwan; Austin, Texas; and Singapore From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, and the Department of General Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Seton Institute of Reconstructive Plastic Surgery; and the Division of Plastic Surgery, Singapore General Hospital.
Plast Reconstr Surg. 2013 Jun;131(6):1286-1298. doi: 10.1097/PRS.0b013e31828bd3b3.
Vascularized groin lymph node flap transfer is an emerging approach to the treatment of postmastectomy upper limb lymphedema. The authors describe the pertinent flap anatomy, surgical technique including different recipient sites, and outcome of this technique.
Ten cadaveric dissections were performed to clarify the vascular supply of the superficial groin lymph nodes. Ten patients underwent vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema using the wrist (n=8) or elbow (n=2) as a recipient site. Ten patients who chose to undergo physical therapy were used as controls. Intraoperatively, indocyanine green was injected subcutaneously on the flap margin to observe the lymph drainage. Outcomes were assessed using improvement of circumferential differentiation, reduction rate, and decreased number of episodes of cellulitis.
A mean 6.2±1.3 groin lymph nodes with consistent pedicles were identified in the cadaveric dissections. After indocyanine injection, the fluorescence was drained from the flap edge into the donor vein, followed by the recipient vein. At a mean follow-up of 39.1±15.7 months, the mean improvement of circumferential differentiation was 7.3±2.7 percent and the reduction rate was 40.4±16.1 percent in the vascularized groin lymph node group, which were statistically greater than those of the physical therapy group (1.7±4.6 percent and 8.3±34.7 percent, respectively; p<0.01 and p=0.02, respectively).
The superficial groin lymph nodes were confirmed as vascularized with reliable arterial perfusion. Vascularized groin lymph node flap transfer using the wrist or elbow as a recipient site is an efficacious approach to treating postmastectomy upper limb lymphedema.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
带血管化腹股沟淋巴结皮瓣转移术是治疗乳腺癌根治术后上肢淋巴水肿的一种新兴方法。作者介绍了相关皮瓣解剖结构、手术技术（包括不同的受区部位）及该技术的效果。
为明确腹股沟浅淋巴结的血供，作者进行了 10 例尸体解剖。10 例乳腺癌根治术后上肢淋巴水肿患者接受了带血管化腹股沟淋巴结皮瓣转移术，其中 8 例采用腕部，2 例采用肘部作为受区。10 例选择接受物理治疗的患者作为对照组。术中在皮瓣边缘皮下注射吲哚菁绿，观察淋巴引流情况。采用周径差改善、减少率和减少蜂窝织炎发作次数来评估结果。
在尸体解剖中，平均识别出 6.2±1.3 个具有一致性蒂的腹股沟淋巴结。吲哚菁绿注射后，荧光从皮瓣边缘排入供区静脉，再排入受区静脉。平均随访 39.1±15.7 个月后，带血管化腹股沟淋巴结组的周径差改善平均为 7.3±2.7%，减少率为 40.4±16.1%，与物理治疗组相比差异有统计学意义（分别为 1.7±4.6%和 8.3±34.7%；p<0.01 和 p=0.02）。
腹股沟浅淋巴结具有可靠的动脉灌注，被证实为血运丰富。采用腕部或肘部作为受区部位的带血管化腹股沟淋巴结皮瓣转移术是治疗乳腺癌根治术后上肢淋巴水肿的有效方法。
临床问题/证据水平：治疗，III 级。
