Research to lessen likelihood of donor site LE

The lymphatic system, lymph vessels and lymph ...

The lymphatic system, lymph vessels and lymph nodes. Español: El sistema linfático; vasos linfáticos y nodulos o ganglios linfáticos. Русский: Лимфасистема с лимфаканалами и узлами. Polski: Układ limfatyczny (chłonny) – rozmieszczenie głównych węzłów i naczyń chlonnych. (Photo credit: Wikipedia)

One if the fears associated with Lymph node Transfer is that patients may get Lymphoedema in the area of donor site. This research is interesting in addressing that problem for the future, by using techniques to map the lymphatics of the donor site and ensuring no nodes are removed which drain a limb. Thanks to my “Reasearch Assistant” in Belgium who keeps me up to date with the latest articles. I am sure we will see more of this work from Dr Dayan in New York.

Vascularized Thoracodorsal and Lateral Thoracic Artery-Based Lymph Node Transfer for the Treatment of Lymphedema: Technique and Case Series
Erez Dayan, M.D., Mark L. Smith, M.D., Mark Sultan, M.D., William Samson, M.D., Joseph H. Dayan, M.D..
Beth Israel Medical Center, New York, NY, USA.

Vascularized groin lymph node transfer has been described as a successful treatment for lymphedema. However, patients with bilateral lower extremity lymphedema may not be candidates, and the short pedicle may not be ideal if the recipient site requires greater pedicle length. Transfer of axillary lymph nodes draining the chest wall has been performed but there is no literature on the technical details of this procedure. We present a case series and technique for vascularized axillary lymph node transfer using reverse lymphatic mapping to minimize the risk of lymphedema in the upper extremity.
Four patients underwent axillary lymph node transfer between October 2011 and June 2012: two patients with lower extremity lymphedema and 2 with upper extremity lymphedema. Reverse lymphatic mapping using technetium injection into the upper extremity and indocyanine green into the chest wall was used to avoid harvesting lymph nodes draining the upper limb and to facilitate chest wall lymph node harvest. Donor lymph nodes were harvested based on the thoracodorsal artery in 2 cases and based on both the thoracodorsal and lateral thoracic arteries in the remaining 2 cases. A thoracodorsal artery perforator skin paddle was included in 3 of the 4 cases. Intravenous indocyanine green and SPY evaluation was used to confirm perfusion of lymph nodes following anastomosis. Video and technical details will be illustrated.
All patients had viable free flap transfers with satisfactory perfusion of the lymph nodes confirmed by intraoperative SPY evaluation. There were no postoperative complications and no observed lymphedema in the limb adjacent to the lymph node harvest donor site. Our first patient experienced a significant reduction in upper extremity limb volume as illustrated in the attached figures. Long-term follow-up on volumetric data and quality of life will be provided at the time of the meeting with a follow-up range of 7 – 15 months.
Axillary lymph node transfer may be a useful alternative to groin lymph nodes and provides a long pedicle which may be preferable in a severely radiated or hostile recipient environment.

Lymphatics of the axillary region

Lymphatics of the axillary region (Photo credit: Wikipedia)

6 thoughts on “Research to lessen likelihood of donor site LE

  1. Dr Chang, (MD Anderson, but who will soon be at University of Chicago) is taking clavicular flaps and transferring those nodes, stating that there is no chance of that area becoming lymphedematous. I wonder why this is not being researched more, rather than taking axillary or groin nodes from a limb area. I worry that the long term future may be a problem if axillary or groin nodes are used.

    • My nodes were taken from the clavicular area and so far so good.. My dr said we have lots of nodes there.. I am not sure what the thinking is by the drs as to where they take nodes from … Quite a few do the Axillary nodes… I guess like everything with this surgery it is a wait and see but I am happy there is proper research going on..

      • i have read before that some doctors prefer not to use clavicular when patient is really skinny and they need some fat to go with the nodes. also some patients do not like idea of harvesting nodes there close to the face and a more visible scar.
        another time i read that a doctor said there are more nerves in that zones.
        also for woman with breastcancer i guess that zone is not an ootion for donor cus they say that with axillar nodes removed and rads,…close to clavicular zone the risk on arm le increases a lot when you have combination of this ….
        so i guess it is good that more donor sites are investigated so they have an option for everybody…

        reverse mapping technique sounds very good. the fact dr.dayan has little persons over two years shows that he founds it important to give as much time to screaning and follow up as surgery. which is good. le is soco.plicage

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