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Anatomical Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomographic Angiography

Howell, Anna C., M.D.; Gould, Daniel J., M.D., Ph.D.; Mayfield, Cory, B.S.; Samakar, Kamran, M.D.; Hassani, Cameron, M.D.; Patel, Ketan M., M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 1046-1052
doi: 10.1097/PRS.0000000000004772
Reconstructive: Trunk: Original Article
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Discussion

Background: The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer. The anatomy of the gastroepiploic vessels, omentum, and lymph nodes has not been investigated. The purpose of this article is to describe the right gastroepiploic artery and related structures by using computed tomographic angiography.

Methods: A retrospective analysis was conducted on 34 patients who underwent computed tomographic angiography. Statistical models were applied to identify right gastroepiploic artery and lymph node anatomical characteristics.

Results: The right gastroepiploic artery was identified in 33 of 34 patients. It was found to have a diameter of 2.49 ± 0.66 mm at its origin. The gastroduodenal artery length before right gastroepiploic artery takeoff was 3.09 ± 1.31 cm. Twenty-five patients had lymph nodes in the right gastroepiploic artery lymphosome. There were 2.7 ± 2.12 lymph nodes identified per patient. The distance from the right gastroepiploic artery origin to the most proximal lymph node was 3.99 ± 2.21 cm. The distance from the gastroepiploic artery origin to the third lymph node was 9.12 ± 5.06 cm. Each lymph node was within 7.00 ± 6.2 mm of the right gastroepiploic artery.

Conclusions: When using the right gastroepiploic artery donor site for vascularized lymph node transfer, the plastic surgeon should anticipate using a pedicle length of 4 cm, a total flap length of 9 cm, and 3 cm of surrounding tissue to obtain at least three lymph nodes for transfer. Computed tomographic angiography is an effective imaging modality that can be used for patient-specific surgical navigation before vascularized lymph node transfer.

Los Angeles, Calif.

From the Keck School of Medicine of the University of Southern California.

Received for publication November 2, 2017; accepted March 29, 2018.

Presented at Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017; and the 2019 American Society for Reconstructive Surgery Annual Meeting, in Phoenix, Arizona, January 13 through 16, 2018.

Disclosure:Dr. Patel is a consultant for Novadaq Corp., and receives textbook royalties from Elsevier Corp. All other authors have no disclosures.

Ketan M. Patel, M.D., Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, Calif. 90033, ketan.patel@med.usc.edu

Copyright © 2018 by the American Society of Plastic Surgeons