Cook Julia A, Sasor Sarah E, Tholpady Sunil S, Chu Michael W
Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Plastic and Reconstructive Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana.
J Reconstr Microsurg. 2018 Sep;34(7):472-477. doi: 10.1055/s-0038-1642637. Epub 2018 Apr 16.
Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest.
Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed -test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA.
In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (< 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups.
The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap.
带血管蒂淋巴结转移术是治疗淋巴水肿越来越常用的方法。网膜供区具有软组织丰富、侧支循环明确、可利用淋巴结数量多且无医源性淋巴水肿风险等优势。本研究旨在明确在带血管蒂淋巴结采集背景下网膜瓣的解剖结构。
回顾了在单一机构1年内连续进行的腹部计算机断层血管造影（CTA）图像。记录右胃网膜动脉（RGEA）长度、动脉管径、淋巴结大小以及淋巴结相对于动脉的位置。采用双尾t检验比较均值。使用经归一化熵准则确认的高斯混合模型计算沿RGEA的三维淋巴结簇位置。
共有156幅CTA图像符合纳入标准。RGEA起始处的管径男性显著大于女性（<0.001）。每位患者平均有3.1（1.7）个淋巴结。在识别出的淋巴结数量上无显著性别差异。男性的平均淋巴结大小显著大于女性（男性为4.9[1.9]×3.3[0.6]mm，女性为4.5[1.5]×3.1[0.5]mm；<0.001）。注意到RGEA走行有三种不同的解剖变异，每种变异都有独特的淋巴结聚集模式。解剖亚组之间的淋巴结总数和大小无差异。
网膜是一个解剖结构一致的可靠淋巴结供区。本研究有助于使用网膜瓣进行带血管蒂淋巴结转移术的术前规划。
