PRS AAPS Oral Proofs 2016
Catherine S. Chang, MD, Jillian Lazor, MD, Jonathan Bank, MD, Patrick Gerety, MD, Joel Stein, MD, Suhail S. Kanchwala, MD
From the University of Pennsylvania, Philadelphia, Pa.
PURPOSE: The ideal donor site for vascularized lymph node transfer is one that is easily accessible, has little risk of donor-site lymphedema, has sufficient nodes and pedicle length, and has a concealable scar. The supraclavicular (SC) lymph node flap meets all of these requirements; however, it has not yet achieved popularity because of concern over its reliable anatomy and sufficient number of lymph nodes. We use magnetic resonance angiography (MRA) to delineate number, size, and location of SC nodes in reference to the transverse cervical artery (TCA).
METHODS: A retrospective review of neck MRAs performed at our institution from January to September 2014 was performed. Thirty studies met inclusion criteria. The right TCA was identified, and the diameter at its origin was measured. Size and distance of SC nodes in 3 dimensions in relation to the TCA origin were measured.
RESULTS: A total of 142 lymph nodes were identified with an average of 4.7 ± 2.2 nodes per patient and mean length of 5.3 ± 2 mm. Average diameter at the TCA origin measured 2.7 ± 0.8 mm. With respect to the TCA origin, all nodes were lateral, 96% superior, and 78% posterior. Average distance from the TCA origin was 37 ± 13 mm, with nodes 19.2 ± 11.8 mm superior, 27.7 ± 11.3 mm lateral, and 23.1 ± 11.8 mm posterior to TCA origin. Twenty-three percent of patients had a separate origin of the TCA from the subclavian artery.
CONCLUSIONS: The SC lymph node flap is ideal for vascularized lymph node transfer. MRA demonstrates sufficient and consistent number of nodes to be transferred, better delineates the anatomy of this flap, and provides useful guidelines for identifying targeted nodes more efficiently.