<< Back to the abstract archive
Jejunal Mesenteric Vascularized Lymph Node Transfer for Treatment of Lymphedema
Steven Schulz, MD, Sumanas W. Jordan, M.D., PhD., Michelle Coriddi, M.D., Joseph Meyerson M.D., Daniel Eiferman, M.D., Roman Skoracki, M.D.
The Ohio State University
2018-02-15
Presenter: Steven Schulz
Affidavit:
Dr. Jordan significantly updated the current series of jejunal VLNTs.
Director Name: Albert Chao
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Donor sites include the groin, axilla, submental and supraclavicular areas. Each site has disadvantages. We have proposed the jejunal mesentery as a reliable donor site with low morbidity. Herein we will review the anatomy of the jejunal mesenteric vascularized LN flap and report our outcomes on all jejunal mesenteric VLNT's performed at our institution to date.
METHODS: Jejunal VLNT was performed for treatment of advanced stage lymphedema. Clinical details, surgical details, and outcomes were retrospectively analyzed.
RESULTS: Twenty-six patients have undergone jejunal VLNT for treatment of upper (53.8%) or lower (46.2%) extremity lymphedema with mean follow-up of 15.2 months. Average age was 58.7 +/- 8.1 years, average BMI was 31.6 +/- 5.84 kg/m2, and all patients presented with MDACC Stage 3 or 4 or had failed previous surgical treatment. Most common etiology of lymphedema was cancer-related (23/26, 88.5%) with a history of lymph node dissection; 14/26 (53.9%) had a history of radiation. Mean number of LN per flap was 3.82 +/- 1.19. There was one takeback for arterial thrombosis, one abdominal wound infection, and three hernias. 14 (63.3%) reported subjective improvement in symptoms, and eight (36.4%) are no longer wearing compression garments.
CONCLUSION: The jejunal VLNT is an excellent option for lymphedema treatment with no risk of donor site lymphedema or nerve damage. Harvest from the periphery of the proximal jejunum is optimal. Improvement in lymphedema can be expected in a majority of patients.
