Ciudad Pedro, Manrique Oscar J, Date Shivprasad, Agko Mouchammed, Perez Coca John Jaime, Chang Wei-Ling, Lo Torto Federico, Nicoli Fabio, Maruccia Michelle, López Mendoza Javier, Chen Hung-Chi
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Department of Biological Science and Technology, China Medical University, Taichung, Taiwan.
Microsurgery. 2017 Oct;37(7):771-779. doi: 10.1002/micr.30168. Epub 2017 Mar 23.
Vascularized lymph node (VLN) transfer for lymphedema treatment has shown promising results. Optimal donor and recipient sites remain a matter of debate. We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.
Between 2014 and 2015, four-patients with upper limb breast cancer-related lymphedema and three-patients with lower limb pelvic cancer-related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42-65 years).
The average flap size after division was 6.3 cm in length (range, 5-7 cm) and 3.4 cm in width (range, 3-4 cm). The mean pedicle length was 3.2 cm (range, 2.5-4 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow-up of 9.7 months (range, 8-11 months), the mean circumference reduction rate was 43.7 ± 2.5% along the entire limb (P < 0.05). No episode of infection was noted postoperatively.
Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.
血管化淋巴结（VLN）转移治疗淋巴水肿已显示出有前景的结果。最佳供区和受区部位仍存在争议。我们描述了一种通过腹腔镜获取的带两级植入的扩大胃网膜VLN皮瓣的技术及结果。
2014年至2015年期间，纳入了4例患有上肢乳腺癌相关淋巴水肿的患者和3例患有下肢盆腔癌相关淋巴水肿且接受了VLN转移的患者。获取后，将胃网膜VLN皮瓣分成两半，分别在肘部和腕部（上肢）或膝部和踝部（下肢）水平植入。患者平均年龄为53.1岁（范围42 - 65岁）。
分割后的皮瓣平均长度为6.3厘米（范围5 - 7厘米），平均宽度为3.4厘米（范围3 - 4厘米）。平均蒂长为3.2厘米（范围2.5 - 4厘米）。所有皮瓣均完全存活。未观察到供区或受区部位并发症。平均随访9.7个月（范围8 - 11个月）时，整个肢体的平均周长减少率为43.7±2.5%（P < 0.05）。术后未观察到感染情况。
双重胃网膜VLN转移至肢体中远端是一种安全的方法，结果非常有前景。该技术可通过以统一方式增强整个患肢的淋巴引流来改善临床结果。此外，腹腔镜获取可降低供区发病率并加快恢复。
