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Vascularized Groin Lymph Node Transfer Using the Wrist as a Recipient Site for Management of Postmastectomy Upper Extremity Lymphedema

Lin, Cheng-Hung M.D.; Ali, Rozina M.D.; Chen, Shin-Cheh M.D.; Wallace, Chris M.D.; Chang, Yu-Chen M.D.; Chen, Hung-Chi M.D.; Cheng, Ming-Huei M.D., M.H.A.

Plastic & Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - pp 1265-1275
doi: 10.1097/PRS.0b013e31819e6529
Hand/Peripheral Nerve: Original Articles

Background: Restoring the continuity of lymphatic drainage by lymphaticovenous or lymphaticolymphatic anastomosis was observed in the short term to be patent but eventually occluded because the elevated interstitial pressure will cause obliteration of these tiny, thin-walled, low-pressure lumens. The purpose of this study was to evaluate the outcome of vascularized groin lymph node transfer using the wrist as a recipient site in patients with postmastectomy upper extremity lymphedema.

Methods: Between January of 1997 and June of 2005, 13 consecutive patients with a mean age of 50.69 ± 11.25 years underwent vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. A vascularized groin lymph node nourished by the superficial circumflex iliac vessels was harvested and transferred to the dorsal wrist of the lymphedematous limb. The superficial radial artery and the cephalic vein were used as the recipient vessels. Outcome was assessed by upper limb girth, incidence of cellulitis, and lymphoscintigraphy.

Results: All flaps survived, and one flap required reexploration, with successful salvage. No donor-site morbidity was encountered. At a mean follow-up of 56.31 ± 27.12 months, the mean reduction rate (50.55 ± 19.26 percent) of the lymphedematous limb was statistically significant between the preoperative and postoperative groups (p < 0.01). The incidence of cellulitis was decreased in 11 patients. Postoperative lymphoscintigraphy indicated improved lymph drainage of the affected arm, revealing decreased lymph stasis and rapid lymphatic clearance. A hypothesis was proposed that the vascularized groin lymph node transfer might act as an internal pump and suction pathway for lymphatic clearance of lymphedematous limb.

Conclusion: Vascularized groin lymph node transfer using the wrist as a recipient site is a novel and reliable procedure that significantly improves postmastectomy upper extremity lymphedema.

Taoyuan, Taiwan

From the Departments of Plastic and Reconstructive Surgery, General Surgery, and Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, and the Department of Plastic and Reconstructive Surgery, E-Da Hospital.

Received for publication March 28, 2008; accepted October 22 2008.

Presented at the 20th Annual Meeting of American Society for Reconstructive Microsurgery, in Los Angeles, California, January 12 through 15, 2008.

Disclosure: None of the authors has any financial disclosures to report in association with this article.

Ming-Huei Cheng, M.D., M.H.A., Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing St. Kuei-Shan, Taoyuan, Taiwan, minghueicheng@gmail.com, minghuei@adm.cgmh.org.tw

©2009American Society of Plastic Surgeons