[Free Microvascular Lymph Node Transplantation from the Omentum for the Treatment of Lymphoedema]

Lymphoedema is a chronic, progressive condition that may occur as a primary disorder or secondarily following lymphatic damage, such as after lymphadenectomy or radiotherapy. Conservative therapies often provide only limited relief, so that surgical approaches like vascularised omental lymph node transfer (VOLT) are increasingly relevant.We present two cases of advanced secondary lower-limb lymphoedema following lymphadenectomy. Both patients demonstrated severe lymphatic transport dysfunction on lymphoscintigraphy and MRI. A double microsurgical lymph node transfer using VOLT was performed in each case. The omentum, selected for its high lymph node density and lymphangiogenic potential, was divided intraoperatively to reconstruct both the groin and lower leg regions. In addition, a systematic literature review on omental lymph node transfer for lymphoedema was conducted using PubMed.In both cases, postoperative assessment confirmed adequate perfusion of the grafts and clinical improvement of lymphoedema symptoms. The literature review revealed consistent evidence of significant limb volume reduction, improved lymphatic drainage, and a marked decrease in the incidence of cellulitis following VOLT.VOLT is an effective surgical option for therapy-refractory lymphoedema and may substantially improve patient quality of life. Despite promising results, further standardised prospective long-term studies are required to validate its efficacy and safety.