Outcomes of Vascularized Lymph Node Transplantation for the Treatment of Lymphedema.

Background A growing body of evidence supports the efficacy of surgical treatments for lymphedema. This study reports the outcomes of vascularized lymph node transplantation (VLNT) for the treatment of patients with lymphedema compared with maximal conservative treatment alone. Study Design Consecutive patients undergoing VLNT to treat primary and secondary lymphedema affecting the upper or lower extremities were included. All patients were optimized preoperatively with conservative therapy. Demographic and treatment information was collected, and outcomes data were electronically captured prospectively; descriptive statistics were performed. Results There were 134 patients included that had achieved maximal reductions by conservative therapy preoperatively. This series included jejunal mesenteric (n=25), groin (n=43), lateral thoracic (n=31), omental/ right gastroepiploic (n=21), and submental (n=14) VLN flaps. At 24 months postoperatively there were significant reductions in limb volume change (LVC) [mean 45.7% (±8.7), p=0.002], LDex score [mean 59.8% (±8.7), p Conclusions Treatment of lymphedema using VLNT resulted in progressive, significant reductions in limb volume, bioimpedance spectroscopy measurements of extracellular fluid, and episodes of cellulitis, with improved patient reported outcomes and limb function measures when compared with maximal conservative therapy alone. The complication rate was low and there were no significant outcomes differences between the VLNT types.