Dozier Peaches A, Reid Adam J, Mailey Brian A
From the Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield, Ill.
Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Louis University School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2023 Aug 22;11(8):e5219. doi: 10.1097/GOX.0000000000005219. eCollection 2023 Aug.
Vascularized lymph node transfer (VLNT) is a surgical option to improve physiologic lymphatic drainage. This technique transfers healthy vascularized lymphatic tissue from various available donor sites to the existing lymphatics of the affected area. Here, we present a successful case halting the size progression and reversing lymphedema symptoms in a patient treated with vascularized omental lymph node transfer. A 56-year-old man presented with stage III malignant sarcoma of his left medial upper arm. Two-years after excision, flap reconstruction, and radiation brachytherapy, worsening diffuse left arm edema developed, causing pain, decreased range of motion, and paresthesia. A vascularized omental lymph node transfer was performed. The omental flap required a flow-through design, requiring anastomosis of both gastroepiploic arteries to obtain Dopplerable signals. The patient experienced progressive relief of lymphedema symptoms after this transfer. Treatment outcomes with the use of VLNT have been largely encouraging; however, objective measures of improvement and timing of neolymphangiogenesis in recipient lymph node sites still need to be defined. Understanding omental VLNT flow dynamics and expected time point changes during the postoperative course will define expected outcomes and allow for treatment of a greater number of patients affected by lymphedema.
带血管蒂淋巴结转移术（VLNT）是一种改善生理性淋巴引流的手术选择。该技术将健康的带血管蒂淋巴组织从多个可用供区转移至患区现有的淋巴管。在此，我们报告一例成功病例，一名接受带血管蒂网膜淋巴结转移术治疗的患者，其上肢淋巴水肿的大小进展得到遏制，症状出现逆转。一名56岁男性，左上肢内侧发生III期恶性肉瘤。切除、皮瓣重建及近距离放射治疗两年后，左侧手臂弥漫性水肿加重，导致疼痛、活动范围减小及感觉异常。遂行带血管蒂网膜淋巴结转移术。网膜瓣需要采用通血设计，即对两条胃网膜动脉进行吻合以获得可检测到的信号。该患者在此次转移术后淋巴水肿症状逐渐缓解。使用VLNT的治疗效果总体令人鼓舞；然而，受体淋巴结部位改善的客观指标以及新生淋巴管生成的时间仍有待确定。了解网膜VLNT的血流动力学及术后过程中预期的时间点变化，将明确预期疗效，并使更多受淋巴水肿影响的患者得到治疗。
