Key Points Superficial inguinal lymph nodes targeted for harvest lie between the groin crease and inguinal ligament. The vascular supply of these nodes is typically the superficial circumflex iliac artery. These nodes typically drain the lower abdomen; however, there are…
Key Points The small bowel mesentery represents a donor site for vascularized lymph node transfer that contains numerous and redundant lymph nodes and has reliable anatomy with minimal donor site morbidity. The small bowel mesenteric lymph node flap can usually…
Key Points Intraoperative mapping of the right gastroepiploic lymphosome is valuable to identify critical flap components. No-touch flap elevation will prevent damage to the flap lymphatics and microvasculature. Harvesting additional capillary networks can minimize venous congestion. Additional vascular anastomoses may…
Key Points The axillary donor site has the highest reported incidence of lymphedema. Preoperative imaging facilitates surgical planning and establishes a baseline for postoperative comparison. Reverse lymphatic mapping identifies lymphatic drainage patterns, identifying lymph nodes for transfer while minimizing the…
Key Points Harvesting lymph nodes from the axillary or groin region may cause secondary lymphedema of the upper or lower extremity. The main advantage of supraclavicular nodes harvest is minimal risk of secondary lymphedema. The flap is designed with or…
Key Points The upper margin of the flap is designed at the lower border of the mandible to result in an inconspicuous scar. Preoperative Doppler ultrasound and magnetic resonance imaging are helpful for evaluating the number of sizable lymph nodes…
Key Points The vascularized lymph node flap transfer from the groin was first introduced by Clodius in 1982 in two clinical cases. Animal studies described the vascularized lymph node flap as an effective technique for the treatment of lymphedema prior…
Key Points A number of different donor sites exist for vascularized lymph node transfer that have near-equivalent success rates in improving the condition of patients suffering from lymphedema. Donor site selection should be based on surgeon comfort and experience, taking…
Key Points Reductive procedures (direct excision with skin grafting or liposuction) alone or as an adjunct are effective in gross reduction of volume; however, they carry significant morbidity. Direct excision with skin grafting is reserved for the most extreme cases…
Key Points Lymphedema is more than mechanical insufficiency due to reduced transport capacity. Lymphedema is an inflammatory edema associated with an increase in the adipose content of the subcutaneous layer and interstitial fibrosis. Complete decongestive therapy is an accepted and…