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Bridging the Gap: Correction of Hand Lymphedema Following Radial Forearm Flap Phalloplasty
Shayan M. Sarrami, MD
Nerone Douglas, MSc
Carolyn De La Cruz, MD
University of Pittsburgh
2024-01-14
Presenter: Shayan M. Sarrami
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. 100% of the work on this project is original work by the authors.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction
Lymphedema is a rare but devastating donor site complication following radial forearm flap (RFF) phalloplasty. We present the case of a 49-year-old transgender male suffering from hand lymphedema due to near-circumferential flap harvest and destruction of lymphatic anatomy. As a novel lymphedema treatment method, we utilized a bridging anterior lateral thigh (ALT) flap with healthy lymphatic channels to restore lymph flow.
Methods
Our patient presented with swelling of his left hand and severe pain after RFF phalloplasty. Preoperative indocyanine green (ICG) lymphography showed diffuse dermal backflow in the hand and no flow in the forearm. An ALT flap was harvested to reconstruct the area. After inset, three venous anastomoses were made to dorsal hand veins to improve outflow and reduce the fluid load on the lymphatic system. The flap was placed within proximity of recipient lymphatics to promote lymphangiogenesis.
Results
At 18-months, swelling at the metacarpophalangeal joints reduced from 20.1cm to 18.5cm. Patient reported outcomes included alleviation of pain, numbness, and restored range of motion at the wrist and digits. On postoperative ICG imaging, there was new lymphatic flow within the forearm. Bridging channels were seen traversing the volar wrist into the ALT flap, demonstrating lymphangiogenesis.
Conclusion
By promoting lymphangiogensis and constructing numerous venous anastomoses we facilitated proper outflow from the extremity and completely resolved the patient's lymphedema. Using ICG we traced the formation of lymphatics from the recipient site into the reconstruction. This adds to the growing body of literature showing free flaps can stimulate physiologic lymph flow.
