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Updated: Apr 11, 2026

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A Practical Algorithm for Donor- and Recipient-site Selection in Vascularized Lymph Node Transfer in Extremity

Elisabeth A Kappos1,2, Adriano Fabi1,2, Vanessa A Müller1,2

  • 1From the Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland.

Plastic and Reconstructive Surgery. Global Open
|April 10, 2026
PubMed
Summary

Vascularized lymph node transfer (VLNT) is effective for lymphedema. Donor site choice minimizes complications, while recipient site selection, like axillary or lower leg placement, optimizes outcomes for better limb volume reduction.

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Area of Science:

  • Microsurgery
  • Lymphedema Management
  • Regenerative Medicine

Background:

  • Vascularized lymph node transfer (VLNT) involves transplanting autologous lymph nodes to lymphedematous areas.
  • Comparative effectiveness and complication rates across different donor and recipient sites require further investigation.

Purpose of the Study:

  • To develop an evidence-based algorithm for selecting donor and recipient sites in VLNT.
  • To analyze the comparative effectiveness and complication rates of various VLNT approaches.

Main Methods:

  • A prospectively maintained database of 161 patients undergoing unilateral VLNT for chronic extremity lymphedema (2016-2023) was reviewed.
  • Surgical effectiveness was evaluated using serial limb circumference measurements.
  • Complications were graded using the Clavien-Dindo classification.

Main Results:

  • Groin flaps were the most common donor sites (80.1%), with comparable long-term effectiveness to thoracic, mesenteric, and omental flaps.
  • Axillary recipient site placement for upper extremity lymphedema yielded superior volume reduction compared to distal forearm placement.
  • Lower leg placement was more effective for lower extremity lymphedema than groin placement.

Conclusions:

  • Donor site selection should prioritize minimizing morbidity due to similar long-term effectiveness.
  • Recipient site selection critically impacts VLNT outcomes, with axillary and lower leg placements showing greater efficacy.
  • The role of scar tissue release in VLNT outcomes may be more significant than previously understood.