Nguyen Alexander T, Suami Hiroo, Hanasono Matthew M, Womack Veda A, Wong Franklin C, Chang Edward I
Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas.
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
J Surg Oncol. 2017 Jan;115(1):84-89. doi: 10.1002/jso.24379. Epub 2016 Jul 20.
The free vascularized omental lymphatic flap provides an option without the risk for iatrogenic donor site lymphedema that plagues alternative lymph node transfer donor sites. The omental flap has been associated with significant morbidity in the past; however, with modern techniques and advanced in technology, a minimally invasive approach to flap harvest is feasible. We present the long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
All consecutive patients with advanced lymphedema undergoing minimally invasive free vascularized omental lymphatic flap transfer were included. Perioperative evaluation included qualitative assessments, lymphoscintigraphy, and volumetric measurements.
Overall, 42 patients underwent a free omental lymphatic flap and had a mean follow-up of 14 (3-32) months. Subjective improvements were noted in 83% of patients. Mean volumetric improvement was 22%. Complications occurred in 16% (n = 7) of patients; this included one episode of pancreatitis and one flap loss. Postoperative imaging revealed viable lymphatic transfers. Cellulitis history was present in 74% (n = 31) patients with post-operative cellulitis occurring in 5% (n = 2) patients.
The minimally invasive free vascularized omental lymphatic flap provides a safe donor site, a durable and versatile flap, and an efficacious therapy against lymphedema and lymphedema-related cellulitis. J. Surg. Oncol. 2017;115:84-89. © 2016 Wiley Periodicals, Inc.
带血管蒂游离网膜淋巴瓣提供了一种选择，可避免困扰其他淋巴结转移供区的医源性供区淋巴水肿风险。过去，网膜瓣与显著的并发症相关；然而，随着现代技术和科技的进步，采用微创方法切取皮瓣是可行的。我们报告了采用微创带血管蒂游离网膜淋巴瓣治疗淋巴水肿的长期疗效。
纳入所有连续接受微创带血管蒂游离网膜淋巴瓣转移术的晚期淋巴水肿患者。围手术期评估包括定性评估、淋巴闪烁显像和容积测量。
总体而言，42例患者接受了游离网膜淋巴瓣手术，平均随访时间为14（3 - 32）个月。83%的患者有主观改善。平均容积改善为22%。16%（n = 7）的患者出现并发症；其中包括1例胰腺炎和1例皮瓣坏死。术后影像学检查显示淋巴转移成活。74%（n = 31）的患者有蜂窝织炎病史，5%（n = 2）的患者术后发生蜂窝织炎。
微创带血管蒂游离网膜淋巴瓣提供了一个安全的供区、一个持久且多功能的皮瓣，以及一种治疗淋巴水肿和与淋巴水肿相关蜂窝织炎的有效疗法。《外科肿瘤学杂志》2017年；115：84 - 89。© 2016威利期刊公司
