Recipient site selection in vascularized lymph node transfer for secondary lymphedema: A systematic review and...

Vascularized lymph node transfer (VLNT) is an established microsurgical approach for secondary lymphedema; however, the optimal recipient site remains uncertain. This systematic review and meta-analysis aimed to compare outcomes between different recipient sites in upper and lower extremity VLNT. Following the PRISMA guidelines, PubMed, Scopus, and ScienceDirect were searched to October 2024. Outcomes assessed included circumferential reduction rate (CRR), volume-based reduction, cellulitis incidence, and quality of life. Meta-analysis was performed using the generic inverse-variance method with random effects. Heterogeneity was assessed using I², and sensitivity and meta-regression analysis explored potential sources of variability. Fifteen studies met the inclusion criteria. Meta-analysis was feasible only for distal inset data due to substantial heterogeneity among proximal and middle sites. Distal inset demonstrated the highest pooled CRR (42.2% for upper extremity and 42.5% for lower extremity), though heterogeneity remained high (I² = 84-91%). Distal placement also showed reduced cellulitis incidence and improved quality of life scores. While distal inset placement yielded the greatest circumferential reduction, outcomes varied widely across studies. No single recipient site was universally superior, optimal selection should be tailored to disease stage, edema distribution, and tissue condition.