Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure

Area of Science:

• Plastic Surgery
• Lymphedema Management
• Microsurgery

Background:

• Endometrial cancer treatment, including hysterectomy, pelvic lymph node dissection, radiation, and chemotherapy, can lead to secondary lower limb lymphedema.
• The patient presented with chronic left lower limb lymphedema for 4 years, complicated by recurrent cellulitis and progressive swelling despite a prior Charles procedure.

Observation:

• A 59-year-old woman with persistent lower limb lymphedema underwent bilateral vascularized submental lymph node flap transfer to the left ankle and thigh.
• The surgical intervention aimed to restore lymphatic drainage and manage chronic swelling and infection.

Findings:

• Postoperatively, the patient experienced significant limb softening and lightening, with a 5-month follow-up showing substantial circumferential reduction.
• Specific reductions included 23.3% above the knee, 50% below the knee, and 22.2% above the ankle.
• The patient reported satisfaction with functional recovery and ceased using compression garments.

Implications:

• Vascularized lymph node transfer is a viable reconstructive option for complex lower limb lymphedema refractory to conventional treatments.
• This microsurgical technique offers a potential solution for improving limb volume, reducing infection recurrence, and enhancing patient quality of life.
• Further research into long-term outcomes and patient selection for lymph node transfer is warranted.