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

Summary Lymphedema is caused by lymphatic dysfunction which leads to progressive limb enlargement. Vascularized lymph node transfer (VLNT) is a microsurgical treatment for lymphedema. Frequently used VLNT donor sites may risk donor-site lymphedema (groin) or require intraperitoneal harvest (right gastroepiploic). The purpose of this study is to describe a novel VLNT using the deep inferior epigastric artery (DIEA) nodes. Patients with lymphedema who underwent VLNT using DIEA nodes were retrospectively reviewed. The lymph nodes were harvested by taking the DIEA with the perivascular adipose near the medial and lateral row branches. Age, affected limb, body mass index (BMI), etiology of lymphedema, stage, recipient vessels, and arm measurements were assessed. Five patients underwent VLNT using DIEA nodes. All patients had upper extremity breast-cancer related lymphedema. Mean age and BMI were 55.6 years and 35.6 kg/m2, respectively. Patients underwent VLNT with DIEA to forearm (radial artery), bilevel VLNT (n=3) with DIEA to forearm or axilla with concurrent other lymph node transfer (right gastroepiploic, superficial groin), and conjoined DIEA nodes with contralateral DIEP flap breast reconstruction (to internal mammary vessels, DIEA nodes to thoracodorsal serratus branch). There were no donor site complications. 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. The lymph nodes can be conjoined with DIEP flap breast reconstruction.