Single-Photon Emission Computed Tomographic Reverse Lymphatic Mapping for Groin Vascularized Lymph Node Transplant...

Area of Science:

• Plastic Surgery
• Lymphedema Management
• Diagnostic Imaging

Background:

• Superficial inguinal (groin) vascularized lymph node transplantation is a primary treatment for lymphedema, often combined with breast reconstruction.
• Accurate presurgical planning is crucial for successful lymph node transplantation and minimizing complications.

Purpose of the Study:

• To evaluate the effectiveness of single-photon emission computed tomographic (SPECT/CT) lymphoscintigraphy for lower extremity reverse lymphatic mapping.
• To assess lymphatic drainage patterns to superficial inguinal lymph nodes for presurgical planning of groin vascularized lymph node transplantation.

Main Methods:

• Retrospective analysis of 84 patients undergoing bilateral lower extremity SPECT/CT reverse lymphatic mapping over five years.
• Data collection included demographics, surgical procedures, and patient outcomes.

Main Results:

• SPECT/CT identified superficial inguinal lymph node drainage in 38.1% of patients to one side and 13.1% to both sides.
• Groin lymph node flap harvest used contralateral side in 98.3% of cases with intraoperative gamma probe guidance.
• No patients developed donor lower extremity lymphedema post-procedure (mean follow-up 34.5 months).

Conclusions:

• Presurgical SPECT/CT reverse lymphatic mapping and intraoperative gamma probe guidance prevent iatrogenic donor lower extremity lymphedema.
• The high incidence of lower extremity lymphatic drainage to the superficial inguinal region necessitates reverse lymphatic mapping for groin lymph node transplantation.