Abstract
Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; thus, some surgeons prefer to use the neck as a donor site. Literature reporting surgical algorithms for the treatment of lymphedema is scarce. Thus, we conducted a systematic review of vascularized omentum lymph node transfer (VOLT) in patients with lymphedema to provide more information about this increasingly common procedure. We hypothesize that the analyzed studies will show that VOLT has positive outcomes. Two reviewers (G.J.C., D.B.) performed independent searches using the PubMed database without timeframe limitations initially through title and abstract descriptions and then by full-text review. The search was done using the following keywords: Breast cancer lymphedema OR lymphedema AND lymph node transfer OR lymph node flap OR lymph node graft AND omental OR omentum OR gastroepiploic. Eligibility criteria included publications evaluating patients with lymphedema in the upper extremity and lower extremity, who underwent VOLT. Our search yielded 35 potential papers in the literature, but only six studies fulfilled the study eligibility criteria. The total number of patients was 137. Three studies described single VOLT, two studies described double VOLT and one study described two cohort patients, one that was treated with single VOLT and another one that was treated with double VOLT. Postoperative reduction of arm circumference, arm volume, and symptoms of the upper extremity were reported in all patients. Nonetheless, in one study, seven patients did not notice any extremity circumference reduction during the follow-up period and four patients noticed an increase in arm volume. Flap loss was reported by two authors in a total of two patients. Overall, patients experienced successful lymphedema treatment with VOLT. All authors presented results with reduced circumferential size of the affected upper and lower limbs, as well as reduction of the infectious intercurrences, such as cellulitis, with a small incidence of associated complications.
Highlights
BackgroundLymphedema is a chronic and progressive disease caused by the impairment of the lymphatic system with the accumulation of proteins in the interstitial fluid, adipose tissue hypertrophy, and fibrosis
Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; some surgeons prefer to use the neck as a donor site
The first authors that described the lymphedema treatment in animals with intra-abdominal-omental tissue were Goldsmith and De Los Santos [18] while the omental transposition to the axilla was reported for the first time by Nakajima et al [19]
Summary
Lymphedema is a chronic and progressive disease caused by the impairment of the lymphatic system with the accumulation of proteins in the interstitial fluid, adipose tissue hypertrophy, and fibrosis. Lymphedema is classified as primary (congenital or idiopathic) or secondary [1,2]. Diagnosis and treatment reduces morbidity and mortality and may help prevent irreversible chronic changes in the limb [3]. Identifying risk factors aids in the prevention of disease onset. Physiologic and excisional procedures to treat lymphedema refractory to conservative therapy have been described [4,5]. The physiologic procedures are lymphovenous anastomosis and lymph node transfer (LNT). The excisional procedures are the radical reduction and preservation of perforators (RRPPs) and suctionassisted lipectomy (SAL)
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