Analysis of different outcome parameters and quality of life after different techniques of free vascularized lymph node transfer

ObjectiveVascularized lymph node transfer (VLNT) has become an important surgical technique in the treatment of lymphedema. Considering the different available regions available for flap harvest, we aimed to analyze different donor sites for VLNT with respect to donor-site morbidity, impact on limb volume and patient-reported outcome measurements (PROMs).MethodsA single-center prospective study on all patients receiving VLNT at the Department of Plastic Surgery and Hand Surgery of the University Hospital Zurich between September 2016 and 2023 was conducted. Lymph nodes were harvested either from the omentum (GE-VLNT), the lateral thoracic wall (LTW) or the superficial inguinal region (SI-VLNT). Volume measurements and PROMs were assessed preoperatively and at different postoperative intervals.ResultsOverall, 70 patients with upper limb lymphedema (21%) or lower limb lymphedema (79%) with different lymphedema stages were included. 49 patients received GE-VLNT, followed by LTW-VLNT (n = 16) and SI-VLNT (n = 5). Lymph node harvest from the superficial inguinal region was associated with a significantly higher frequency of seroma development. Average percentage volume loss related in comparison to the preoperative volume of the affected limb was 9% after GE-VLNT, 10% after LTW-VLNT and 5% after SI-VLNT without a significant difference between the groups. PROMs revealed significant improvements for physical functioning, symptoms and psychological well-being, with no difference between VLNT techniques.ConclusionsVLNT leads to a significant improvement of quality of life and can effectively reduce limb volume, regardless of the selection of donor-site. GE-VLNT has become our flap of choice due to its low donor-site morbidity and its properties that allow a double transplantation while avoiding a second donor-site.