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Novel Vascularized Lymph Node Transfer using a Split Latissimus Dorsi Flap Transfer with for Concomitant Lower Extremity Reconstruction and Lymphedema Treatment
Fiona Freagomen, James Gatherwright, MD
Case Western Reserve University School of Medicine and The Cleveland Clinic Department of Plastic an
2024-01-15
Presenter: Fiona Freagomen
Affidavit:
James Gatherwright
Director Name: James Gatherwright
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Vascularized lymph node transfers (VLNTs) are increasingly used to treat secondary lymphedema due to cancer-related treatments. Inguinal and supraclavicular VLNT are commonly used, while axial VLNT is less commonly used because it is anatomically variable and requires reverse lymph node mapping. However, axillary VLNT shows promise in restoring lymphatic function with close anatomical access to the Type V latissimus dorsi flap. In this case report, the split latissimus dorsi flap (s-LDF) harvest technique was integrated with axillary VLNT techniques for a patient with wide excision melanoma and lymphedema.
Methods: We present the case of a 72-year-old male diagnosed with melanoma in his right lower extremity, who underwent prior excision, groin dissection, and liver transplantation. Three years later, the patient developed stage 3 recurrent skin metastasis accompanied by grade II-III lymphedema. Therefore, the patient underwent a wide local excision and s-LDF coverage combined with axillary VLNT and end-to-end anastomosis of thoracodorsal vessels with posterior tibial vessels. Reverse mapping was used to harvest axillary lymph, and dye uptake confirmed successful VLNT from the axilla to the defect.
Results: Post-operatively, the patient showed full soft tissue coverage, significant healing with no infection, and improved lymphedema symptoms three months after surgery.
Conclusion: Axillary VLNT with s-LDF was chosen due to extensive excision needs and the patient's medical history. This method provided sufficient soft tissue coverage and lymphatic repair while allowing supine surgical positioning. Given its potential, further research into s-LDF axillary VLNTs is encouraged to establish its efficacy and replicability in similar cases.
