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Mesoappendix as potential donor site for vascularized lymph node transfer: anatomic study
Daniel Ruter, Wei Chen, Ramon Garza III, Daniel Eiferman, Roman Skoracki
The Ohio State University College of Medicine
2018-01-31
Presenter: Daniel Ruter
Affidavit:
Daniel Ruter has led this project from start to finish with the assistance of his co-authors. He has played an integral role in all stages from design and IRB submission to data acquisition, analysis and interpretation.
Director Name: Gregory Pearson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: The standard of care for treatment of lymphedema is manual lymphatic drainage and compression therapy, which is time intensive and requires a life-long commitment. Autologous lymph node transfer (ALNT) is a microsurgical treatment in which a vascularized lymph node flap is harvested with its blood supply and transferred to the lymphedematous region to assist with lymph fluid clearance. An ideal donor lymph node site minimizes the risk of iatrogenic lymphedema and other donor site morbidity. To address this, we have utilized jejunal mesentery lymph nodes and omental flaps, and hypothesize that the mesoappendix, as a "spare part", may be an ideal ALNT donor site.
Methods: In this IRB approved study, 25 mesoappendix pathology specimens resected for benign disease underwent gross pathologic examination for the presence of lymph nodes and measurement of the appendicular artery and vein caliber and length.
Results: A single lymph node was present in two of 25 specimens (8%). Mean arterial and vein calibers at the point of ligation were 0.87 +/- 0.44 mm and 0.86 +/- 0.48 mm (range 0.30 – 2.2 mm and 0.25 – 2.2 mm). Mean arterial and vein length was 1.70 +/- 1.06 cm and 1.84 +/- 1.09 cm (range 0.8 – 4.5 cm for each).
Conclusion: The mesoappendix rarely contains a lymph node. The artery and vein calibers of 46% of the specimens were greater than 0.8 mm, the minimum caliber preferred for microsurgical anastomosis. If transplantation of a vascularized lymph node for the treatment of lymphedema is desired, the mesoappendix is inconsistent in providing adequate lymph nodes.
