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

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.