Broyles Justin M, Smith Jeffrey M, Wong Franklin C, Hanasono Matthew M, Chang Edward I, Kappadath S Cheenu, Schaverien Mark V
From the Department of Plastic Surgery, Division of Surgery; Department of Nuclear Medicine, Division of Diagnostic Imaging; and Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2022 Oct 1;150(4):869e-879e. doi: 10.1097/PRS.0000000000009557. Epub 2022 Aug 4.
Superficial inguinal (groin) vascularized lymph node transplantation is the most common option for the treatment of lymphedema, particularly in combination with free abdominal flap breast reconstruction. This study examines the utility of single-photon emission computed tomographic (SPECT/CT) lymphoscintigraphy for lower extremity reverse lymphatic mapping in presurgical planning for groin vascularized lymph node transplantation and appraises the physiologic lymphatic drainage to the superficial inguinal lymph nodes.
All patients who underwent bilateral lower extremity SPECT/CT reverse lymphatic mapping over a 5-year period were included. Retrospective case note analysis was performed to collect demographic, surgical, and outcomes data.
The study included 84 patients; 56 of these subsequently underwent groin vascularized lymph node transplantation (58 flaps). Fifty-four of these flaps were combined with free abdominal flaps for breast reconstruction (55 flaps). Using SPECT/CT reverse lymphatic mapping investigation of 168 inguinal regions, drainage to at least one superficial inguinal region was visualized in 38.1 percent of patients; in 13.1 percent, drainage was visualized to both superficial inguinal regions. Using this information for presurgical planning, groin vascularized lymph node flap harvest was performed from the contralateral side in 57 of 58 cases (98.3 percent) using intraoperative gamma probe guidance, and no patient developed donor lower extremity lymphedema during follow-up (mean ± SD, 34.5 ± 15.4 months).
The authors' use of presurgical SPECT/CT reverse lymphatic mapping together with limited flap dissection and intraoperative gamma probe guidance resulted in no clinical cases of iatrogenic donor lower extremity lymphedema. The high incidence of drainage from the lower extremity to the superficial inguinal region mandates the use of reverse lymphatic mapping when performing groin vascularized lymph node transplantation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
浅表腹股沟（腹股沟）带血管淋巴结移植是治疗淋巴水肿最常用的方法，尤其是与游离腹壁皮瓣乳房重建联合使用时。本研究探讨单光子发射计算机断层扫描（SPECT/CT）淋巴闪烁显像在腹股沟带血管淋巴结移植术前规划中用于下肢逆向淋巴管造影的效用，并评估至浅表腹股沟淋巴结的生理性淋巴引流。
纳入所有在5年期间接受双侧下肢SPECT/CT逆向淋巴管造影的患者。进行回顾性病例记录分析以收集人口统计学、手术和结局数据。
该研究纳入了84例患者；其中56例随后接受了腹股沟带血管淋巴结移植（58块皮瓣）。这些皮瓣中有54块与游离腹壁皮瓣联合用于乳房重建（55块皮瓣）。通过对168个腹股沟区域进行SPECT/CT逆向淋巴管造影检查，38.1%的患者可见至少一个浅表腹股沟区域有引流；13.1%的患者可见双侧浅表腹股沟区域均有引流。利用该信息进行术前规划，58例中有57例（98.3%）在术中γ探测器引导下从对侧获取腹股沟带血管淋巴结皮瓣，随访期间（平均±标准差，34.5±15.4个月）无患者发生供体下肢淋巴水肿。
作者使用术前SPECT/CT逆向淋巴管造影，结合有限的皮瓣解剖和术中γ探测器引导，未出现医源性供体下肢淋巴水肿的临床病例。下肢至浅表腹股沟区域的高引流发生率要求在进行腹股沟带血管淋巴结移植时使用逆向淋巴管造影。
临床问题/证据水平：治疗性，IV级。
