Vascularized Lymphatic Tissue Transfer for Treatment of Lower Limb Lymphedema: Does the Recipient Site Matter?

Introduction: Vascularized lymph node transfer (VLNT) is a pivotal component in lower limb lymphedema (LLL) treatment.We aimed to assess the association of using the groin and ankle as single or multilevel recipient sites on both limb volume reduction and recipient site morbidity.Methods: A total of 51 patients with LLL received VLNT between 2016 and 2023.We assessed volume preoperatively and postoperatively over a 12-mo period.We compared limb volume changes in primary lymphedema (PLE) and secondary lymphedema (SLE) subgroups depending on recipient sites: groin, ankle, and multilevel (groin and ankle).Recipient site complications were noted.Results: Multilevel inset showed a higher volume reduction than the single level proximally (P = 0.002) or distally (P = 0.002) predominantly in PLE.No difference was found between distal and proximal recipient sites alone.In SLE, we did not observe a higher volume reduction with a multilevel approach.Multilevel inset showed a lower ratio of major recipient site complications.Conclusions: Limb volume reduction in VLNT varies depending on the recipient site.In PLE, a multilevel approach showed higher volume reduction without an increase in complication rates and might thus be favored.Single-level proximal and multilevel insets showed similar outcomes in our small SLE cohort, indicating that a single-level approach may be adequate, although validation in larger studies is required.