Deep Inferior Epigastric Artery Vascularized Lymph Node Transfer: A Simple and Safe Option for Lymphedema

Abstract

Background: Vascularized lymph node transfer (VLNT) is a microsurgical treatment for lymphedema. Frequently used VLNT donor sites may risk donor-site lymphedema (inguinal) or require intraperitoneal harvest (gastroepiploic). The purpose of this study was to describe a novel VLNT using the deep inferior epigastric artery (DIEA) nodes. Methods: Patients who underwent VLNT using DIEA nodes between 2015 to 2019 were evaluated. Factors including age, affected limb, body mass index, co-morbidities, etiology, stage, recipient site/vessels, and arm measurements were assessed. Arm measurements at the wrist, forearm, and upper arm were recorded. Circumferential differentiation (circumference of the lesion limb minus the healthy limb, divided by that of the healthy limb) was calculated. Results: Four patients underwent VLNT using DIEA nodes. All patients were female with upper extremity breast-cancer related lymphedema. Age and BMI were 54.8 +/- 10/4 and 35.7 +/- 7.4, respectively. Patients underwent VLNT with DIEA to forearm (radial artery, n=2), wrist (bilevel VLNT with DIEA to radial artery and right gastroepiploic VLNT to axilla to n=1), and conjoined with contralateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction (n=1). There were no donor site complications. All patients reported subjective improvements of their symptoms. The mean circumferential differentiation averaged across all sites was 5.3% at 9 months. Conclusion: Vascularized transfer of the DIEA nodes is a novel technique for treatment of lymphedema. Advantages of this technique include avoiding the risk of donor site lymphedema and convenient access during abdominally based autologous breast reconstruction.