From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plast Reconstr Surg. 2022 Mar 1;149(3):542e-546e. doi: 10.1097/PRS.0000000000008831.
Vascularized lymph node transplantation is a surgical approach for the treatment of chronic lymphedema. However, there is no clinical standard for flap placement nor vascular anastomoses. The authors propose a novel flowthrough configuration for an omental vascularized lymph node transplant in the popliteal space. To prepare the popliteal space for an omental free flap, the medial popliteal fat pad and medial head of the gastrocnemius muscle were debulked. Venous anastomoses were completed with vein couplers, joining the right gastroepiploic vein to the medial sural venae comitantes and the left gastroepiploic vein to the lesser saphenous vein. Arterial anastomoses were hand sewn, joining the right gastroepiploic artery to the proximal medial sural artery and the left gastroepiploic artery to the distal medial sural artery, to create the flowthrough configuration. A retrospective review of patients who underwent this procedure at a single institution was performed. Six patients with chronic lymphedema of the lower extremity underwent vascularized lymph node transplantation from June of 2019 to November of 2020. Five patients underwent at least 3 months of postoperative surveillance, with no postoperative complications reported. In this technique contribution, the authors describe a novel flowthrough configuration for an omental free flap to the popliteal space. The popliteal space offers an aesthetically favorable recipient location when appropriately prepared. The medial sural vessels are ideal recipient vessels for the flowthrough omental flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
带血管淋巴结移植是治疗慢性淋巴水肿的一种手术方法。然而，目前尚没有关于皮瓣放置和血管吻合的临床标准。作者提出了一种新的方法，即将网膜血管化淋巴结移植到腘窝空间中，形成一个直通式结构。为了在腘窝空间中准备网膜游离皮瓣，作者切除了内侧腓肠肌脂肪垫和内侧腓肠肌头部。静脉吻合采用静脉连接器完成，将右胃网膜静脉与内侧腓肠肌伴行静脉连接，将左胃网膜静脉与小隐静脉连接。动脉吻合采用手工缝合，将右胃网膜动脉与近端内侧腓肠动脉连接，将左胃网膜动脉与远端内侧腓肠动脉连接，形成直通式结构。对在一家机构接受该手术的患者进行了回顾性研究。2019 年 6 月至 2020 年 11 月，有 6 例下肢慢性淋巴水肿患者接受了带血管淋巴结移植。5 例患者接受了至少 3 个月的术后随访，未报告术后并发症。在这项技术贡献中，作者描述了一种新的方法，即将网膜游离皮瓣移植到腘窝空间中，形成一个直通式结构。适当准备后，腘窝空间提供了一个美观的受区位置。直通式网膜皮瓣的理想受区血管是内侧腓肠肌血管。
临床问题/证据水平：治疗，IV。
