D30. Immediate Lymphatic Reconstruction (ILR) with Vascularized Lymph Node Transplant (VLNT)

Abstract

PURPOSE: Patients undergoing exanteration of axillary/groin lymph nodes and radiation are at risk not only for lymphedema but painful contracture and limited range of motion (ROM). Traditional immediate-lymphatic-reconstruction (ILR) addresses the lymphatic defect but not the soft tissue one. The purpose of this study was to evaluate the safety and efficacy of ILR with a vascularized-omentum-lymphatic-transplant (VOLT) to reduce the risk of both contracture and lymphedema development in patients with extensive disease. METHODS: Patients with an overwhelming risk of developing severe lymphedema and contracture were offered VOLT at the time of axillary/groin dissection at a tertiary-cancer-center between 2016 to 2021. Demographic data, volume-measurements, Quality-of-Life scores, and cellulitis episodes were recorded. RESULTS: A total of eight patients underwent ILR with VOLT at the time of axillary (n=4)/groin (n=4) dissection. No complications were observed (0%). The mean follow-up time was 30.7±12 months. Three patients (37.5%) developed lymphedema. One patient (12.5%) experienced one episode of cellulitis. Limited ROM during abduction was reported by 3 patients (37.5%). The mean Lymphedema-Life-Impact-Scale (LLIS) scores after surgery reflected minimal Quality-of-Life impairment globally (7.6±14.4%), physically (2.6±4.6%), psychologically (1.2±2.8%) and functionally (1.3±2.3%). CONCLUSION: This is the first study to report ILR with VOLT. VOLT is a safe and reliable option for immediate-reconstruction of the highest-risk patient group who are almost certain to develop not only lymphedema but severe contracture and functional disability. While larger studies are required to better determine indications and outcomes, it is preferable to replace soft-tissue prior to radiation to mitigate pain and contracture.