Jejunal Mesenteric Vascularized Lymph Node Transplantation for Lymphedema: Outcomes and Technical Modifications

Area of Science:

• Vascularized lymph node transplantation
• Microsurgery
• Lymphedema treatment

Background:

• The jejunal mesentery is a viable site for vascularized lymph node transplantation.
• This technique avoids donor-site lymphedema.
• A novel approach harvests flaps from the mesenteric root to minimize small bowel ischemia risk.

Purpose of the Study:

• To report the technique and outcomes of jejunal mesenteric vascularized lymph node transplantation.
• To evaluate the efficacy of this novel approach in treating upper extremity lymphedema.
• To assess the impact on limb volume, extracellular fluid, and patient-reported outcomes.

Main Methods:

• A series of patients with upper extremity lymphedema underwent jejunal mesenteric vascularized lymph node transplantation.
• Preoperative and postoperative measurements included Perometer volumetry and LDex bioimpedance spectroscopy.
• Patient-reported outcomes were assessed using the Lymphedema Life Impact Scale and Quick Disabilities of the Arm, Shoulder and Hand tool.

Main Results:

• At 12 months, limb volume difference decreased by 36.7% (p < 0.001).
• LDex scores reduced by 41.4% (p = 0.0015), and patient-reported scores improved significantly.
• No postoperative cellulitis episodes were reported in patients with a history of the condition (p < 0.001).

Conclusions:

• Jejunal mesenteric vascularized lymph node transplantation is an effective surgical treatment for upper extremity lymphedema.
• The procedure leads to reduced limb volume and extracellular fluid.
• It significantly improves patient-reported limb function and outcomes compared to conservative therapy alone.