The authors investigate the outcome and efficacy of vascularized groin lymph node transfer for the reconstruction of post-mastectomy upper extremity lymphedema.
Thirteen consecutive patients were included in this study that had post-mastectomy upper extremity lymphedema and confirmed to have proximal lymphatic obstruction by lymphoscintigraphy. All patients had failed conservative management. Patients underwent vascularized lymph node transfer by means of a modified groin skin flap that included superficial inguinal lymph nodes to the dorsum of the wrist. The flap’s superficial circumflex iliac artery pedicle was anastomosed to the radial artery and the venous outflow was the cephalic vein. At the mean follow-up of 56 months, the results revealed statistically significant mean lymphedema reduction rate of 50 percent. Post-operative lymphoscintigraphy revealed improved lymphatic drainage of the extremity and decreased lymphatic stasis.
Post-mastectomy upper extremity lymphedema is a commonly found complication that can carry significant functional and infectious sequelae. Treatment includes conservative management or the surgical restoration of lymphatic drainage continuity. Lymphaticovenous or lymphaticolymphatic anastomoses are technically difficult and unreliable as they are thought to eventually occlude. The authors describe vascularized groin lymph node transfer using the wrist as a recipient site. This is a truly novel and seemingly more reliable procedure. Although, much less technically difficult than lymphaticovenous or lymphaticolymphatic bypass procedures, it is still a time consuming and technically demanding microvascular operation because of the short vascular pedicle. However, it may be a promising technique for a difficult problem and warrants further investigation.