Department of Plastic and Reconstructive Surgery, Centre for Surgical Treatment of Lymphedema, Università Cattolica del "Sacro Cuore" - Fondazione Policlinico "A. Gemelli" IRCSS - Largo A. Gemelli 8, 00169 Rome, Italy.
Nuclear Medicine Unit - Ospedale Cristo Re, via delle Calasanziane, 25, 00167 Rome, Italy.
J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):211-215. doi: 10.1016/j.bjps.2018.10.010. Epub 2018 Nov 19.
We report our clinical experience of a supraclavicular lymph node flap (LNF) using a novel method of harvesting based on the compartimental lymphatic and vascular anatomy of the right posterior neck triangle, which allows to harvest two independent LNFs from the same donor site.
We report a case series of 10 consecutive patients affected by cancer-related lower extremity lymphedema, who underwent compartimental dual LNF transfer from the right supraclavicular area to the affected lower limb, from August 2015 to March 2017. The superficial compartment flap (venous flap along the external jugular vein) was anastomosed in a flow-through fashion along the course of the great saphenous vein in the knee region, whereas the deep compartment flap (transverse cervical artery/vein flap) was anastomosed in an end-to-end fashion to the medial sural artery and comitantes vein. Flap viability was checked by color Doppler ultrasound postoperatively. Patients were assessed preoperatively and underwent follow-up at 6 and 12 months after surgery. Data were prospectively collected.
All the flaps resulted to be viable. No major postoperative complications were observed neither at the donor nor at the recipient sites. Patients did not report dysesthesia of the homoteral chest. An overall reduction in the lower extremity lymphedema (LEL) index (mean ± SD: 33.7 ± 22.5) and an improvement in the lymph flow and tracer appearance time at postoperative lymphoscintigraphy were observed. All the patients reported an improved quality of life after surgery.
Compartimental supraclavicular dual LNF harvest seems promising in the treatment of peripheral lymphedema. Sparing of supraclavicular nerves might reduce the morbidity associated with the conventional surgical approach. Larger studies are needed to confirm our findings.
IV, therapeutic study.
我们报告了一种基于右颈后三角区的分区淋巴管和血管解剖结构的新型锁骨上淋巴结皮瓣（LNF）的临床经验，该方法可从同一供体部位采集两个独立的 LNF。
我们报告了 2015 年 8 月至 2017 年 3 月期间，10 例连续癌症相关下肢淋巴水肿患者采用分区双 LNF 转移的病例系列研究。采用顺行方式将浅层皮瓣（沿颈外静脉的静脉皮瓣）吻合至膝部大隐静脉的走行，而深层皮瓣（颈横动脉/静脉皮瓣）则端端吻合至内侧腓肠动脉和伴行静脉。术后通过彩色多普勒超声检查皮瓣的存活情况。患者在术前和术后 6 个月及 12 个月进行随访，并前瞻性收集数据。
所有皮瓣均存活。供区和受区均未出现重大术后并发症。患者未报告对侧胸部感觉异常。下肢淋巴水肿（LEL）指数（平均 ± 标准差：33.7 ± 22.5）整体降低，淋巴闪烁显像术后淋巴流量和示踪剂出现时间改善。所有患者术后生活质量均得到改善。
分区锁骨上双 LNF 采集术在治疗周围性淋巴水肿方面具有前景。保留锁骨上神经可能会降低传统手术方法相关的发病率。需要更大规模的研究来证实我们的发现。
IV，治疗性研究。
