July 20, 2020
Where can lymph nodes be taken for vascularized lymph node surgery?
In a first-of-its-kind study, Dr. Ochoa and the PRMA research team have concluded that the deep inferior epigastric lymph node basin is a successful and innovative donor site option for Vascularized Lymph Node Transfer.
Lymphedema is a chronic condition where excess fluid collects in the body causing swelling. Most commonly, breast cancer-related lymphedema occurs in the arms. Vascularized Lymph Node Transfer is a procedure used to try and reduce or even eliminate the symptoms of lymphedema. Often times, this procedure is performed in conjunction with DIEP flap breast reconstruction.
This study provides evidence that lymph nodes taken from the DIEP flap donor site are a viable option.
You can read the abstract below:
Introduction: Breast cancer-related extremity lymphedema is a potentially devastating condition. Vascularized lymph node transfer (VLNT) has shown benefit in lymphedema treatment. Due to concerns over potential iatrogenic complications, various donor sites have been described. The current study aims at defining the deep inferior epigastric lymph node basin as a novel donor site for VLNT.
Methods: A retrospective study was performed on patients undergoing routine abdominal based breast reconstruction. Resection of all perivascular adipose and lymphatic tissue surrounding the proximal deep inferior epigastric pedicle was performed at the time of pedicle dissection and submitted for Pathologic evaluation. Patient demographics and pertinent medical/surgical history was obtained from medical records.
Results: Specimens were obtained from 10 consecutive patients. Seven patients underwent bilateral reconstruction for a total of 17 specimens obtained. Mean patient age and BMI were 48 years 9.4 and 27 4.2, respectively. Fourteen out of 17 (82%) specimens contained viable lymph nodes displaying a thin fibrous connective tissue capsule overlying an unremarkable subcapsular sinus with a cortex and paracortex containing germinal centers composed of B lymphocytes, tangible body macrophages, and T-cells. The medullary sinus space displayed a fatty unremarkable hilum. The mean number and size of lymph nodes were 2.6 1.2 nodes/specimen and 3.67 mm 2.3, respectively. All patients experienced an uneventful postoperative course without evidence any of compromised flap viability.
Conclusion: Lacking previous description, the deep inferior epigastric lymph node basin is a readily accessible donor site with significant anatomic advantages for potential VLNT during autologous breast reconstruction
Author: Dr. Minas Chrysopoulo and Courtney Floyd
Vascularized Lymph Node Transfer is a procedure used to try and reduce or even eliminate the symptoms of lymphedema. Often times, this procedure is performed in conjunction with DIEP flap breast reconstruction.
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