Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
J Vasc Surg Venous Lymphat Disord. 2024 Nov;12(6):101934. doi: 10.1016/j.jvsv.2024.101934. Epub 2024 Jun 24.
Vascularized lymph node transfer (VLNT) has become an important surgical technique in the treatment of lymphedema. Considering the different available regions available for flap harvest, we aimed to analyze different donor sites for VLNT with respect to donor site morbidity, impact on limb volume, and patient-reported outcome measurements (PROMs).
A single-center prospective study of all patients undergoing VLNT at the Department of Plastic Surgery and Hand Surgery of the University Hospital Zurich between September 2016 and 2023 was conducted. Lymph nodes were harvested either from the omentum (gastroepiploic [GE]-VLNT), the lateral thoracic wall (LTW), or the superficial inguinal region (SI-VLNT). Volume measurements and PROMs were assessed preoperatively and at different postoperative intervals.
Overall, 70 patients with upper limb lymphedema (21%) or lower limb lymphedema (79%) with different lymphedema stages were included. There were 49 patients who underwent GE-VLNT, followed by LTW-VLNT (n = 16) and SI-VLNT (n = 5). Lymph node harvest from the SI was associated with a significantly higher frequency of seroma development. The average percentage volume loss related in comparison to the preoperative volume of the affected limb was 9% after GE-VLNT, 10% after LTW-VLNT, and 5% after SI-VLNT without a significant difference between the groups. PROMs revealed significant improvements for physical functioning, symptoms and psychological well-being, with no differences between the VLNT techniques.
VLNT leads to a significant improvement of quality of life and can decrease limb volume effectively, regardless of the selection of donor site. GE-VLNT has become our flap of choice owing to its low donor site morbidity and its properties that allow a double transplantation while avoiding a second donor site.
血管化淋巴结转移（VLNT）已成为治疗淋巴水肿的重要手术技术。考虑到可供皮瓣采集的不同区域，我们旨在分析 VLNT 不同供区部位的供区发病率、对肢体体积的影响以及患者报告的结局测量（PROMs）。
对 2016 年 9 月至 2023 年期间在苏黎世大学医院整形与手外科接受 VLNT 的所有患者进行了单中心前瞻性研究。从网膜（胃网膜[GE]-VLNT）、侧胸壁（LTW）或浅腹股沟区（SI-VLNT）采集淋巴结。术前和不同术后间隔评估体积测量和 PROMs。
共有 70 例上肢淋巴水肿（21%）或下肢淋巴水肿（79%）患者，不同淋巴水肿阶段，包括 49 例行 GE-VLNT，其次是 LTW-VLNT（n=16）和 SI-VLNT（n=5）。SI 处的淋巴结采集与血清肿发展的频率显著增加相关。与受累肢体术前体积相比，GE-VLNT 后平均体积损失百分比为 9%，LTW-VLNT 后为 10%，SI-VLNT 后为 5%，各组之间无显著差异。PROMs 显示身体功能、症状和心理幸福感显著改善，VLNT 技术之间无差异。
VLNT 可显著提高生活质量，并有效降低肢体体积，无论选择供区部位如何。GE-VLNT 已成为我们的首选皮瓣，因为其供区发病率低，且具有双重移植的特性，同时避免了第二个供区。
