Coriddi Michelle, Kenworthy Elizabeth, Weinstein Andrew, Mehrara Babak J, Dayan Joseph H
Department of Surgery, Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
J Surg Oncol. 2018 Jul;118(1):109-112. doi: 10.1002/jso.25126. Epub 2018 Jun 19.
Vascularized omentum lymphatic transplant (VOLT) for treatment of lymphedema has become popular because of no risk of iatrogenic lymphedema and abundant lymphatic tissue. However, perfusion to the omentum can be difficult to assess clinically. The purpose of this study was to clarify the incidence and degree of ischemia in the omentum.
A retrospective study was conducted to review indocyanine green perfusion findings on patients undergoing VOLT. Patients were placed into 4 categories based on the percentage surface area of omentum that was ischemic: normal, less than 25%, between 25% and 50%, and greater than 50% ischemic. Spearman correlation was performed to determine whether an association exists between prior abdominal surgery and the presence of ischemia.
Twenty-six patients underwent VOLT for treatment of extremity lymphedema. Twelve (46.2%) patients had normal perfusion, 8 patients (30.8%) had less than 25% ischemia, and 6 patients (23.1%) had 25% to 50% ischemia. Prior abdominal surgery was not significantly associated with the presence of ischemia.
Normal flap perfusion is a requisite for successful VOLT harvest. However, over half the patients had some degree of abnormal perfusion irrespective of prior abdominal surgery. Indocyanine green angiography is an important tool in ensuring a healthy lymphatic reconstruction.
带血管蒂大网膜淋巴移植术（VOLT）治疗淋巴水肿已较为流行，因其不存在医源性淋巴水肿风险且淋巴组织丰富。然而，临床上难以评估大网膜的灌注情况。本研究旨在明确大网膜缺血的发生率及程度。
进行一项回顾性研究，以回顾接受VOLT治疗患者的吲哚菁绿灌注结果。根据大网膜缺血表面积的百分比将患者分为4类：正常、缺血面积小于25%、缺血面积在25%至50%之间以及缺血面积大于50%。采用Spearman相关性分析来确定既往腹部手术与缺血情况之间是否存在关联。
26例患者接受VOLT治疗肢体淋巴水肿。12例（46.2%）患者灌注正常，8例（30.8%）患者缺血面积小于25%，6例（23.1%）患者缺血面积在25%至50%之间。既往腹部手术与缺血情况无显著关联。
皮瓣灌注正常是成功进行VOLT手术的必要条件。然而，无论既往是否进行过腹部手术，超过半数的患者存在一定程度的灌注异常。吲哚菁绿血管造影术是确保健康淋巴重建的重要工具。
