Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema
Corresponding Author
Alexander T. Nguyen MD, FACS, CLT
Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas
Correspondence to: Alexander T. Nguyen, MD, FACS, CLT, Integrative Lymphedema Institute, Pine Creek Medical Center, 9080 Harry Hines Blvd. Suite 201, Dallas, TX 75235. Fax: +1-214-351-8491. E-mail: [email protected]
Search for more papers by this authorHiroo Suami MD, PhD
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
Search for more papers by this authorMatthew M. Hanasono MD, FACS
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorVeda A. Womack MBA, PA-C
Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas
Search for more papers by this authorFranklin C. Wong MD, PhD, JD
Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorEdward I. Chang MD, FACS
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorCorresponding Author
Alexander T. Nguyen MD, FACS, CLT
Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas
Correspondence to: Alexander T. Nguyen, MD, FACS, CLT, Integrative Lymphedema Institute, Pine Creek Medical Center, 9080 Harry Hines Blvd. Suite 201, Dallas, TX 75235. Fax: +1-214-351-8491. E-mail: [email protected]
Search for more papers by this authorHiroo Suami MD, PhD
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
Search for more papers by this authorMatthew M. Hanasono MD, FACS
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorVeda A. Womack MBA, PA-C
Integrative Lymphedema Institute, Pine Creek Medical Center, Dallas, Texas
Search for more papers by this authorFranklin C. Wong MD, PhD, JD
Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorEdward I. Chang MD, FACS
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
Search for more papers by this authorAbstract
Background
The free vascularized omental lymphatic flap provides an option without the risk for iatrogenic donor site lymphedema that plagues alternative lymph node transfer donor sites. The omental flap has been associated with significant morbidity in the past; however, with modern techniques and advanced in technology, a minimally invasive approach to flap harvest is feasible. We present the long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
Methods
All consecutive patients with advanced lymphedema undergoing minimally invasive free vascularized omental lymphatic flap transfer were included. Perioperative evaluation included qualitative assessments, lymphoscintigraphy, and volumetric measurements.
Results
Overall, 42 patients underwent a free omental lymphatic flap and had a mean follow-up of 14 (3–32) months. Subjective improvements were noted in 83% of patients. Mean volumetric improvement was 22%. Complications occurred in 16% (n = 7) of patients; this included one episode of pancreatitis and one flap loss. Postoperative imaging revealed viable lymphatic transfers. Cellulitis history was present in 74% (n = 31) patients with post-operative cellulitis occurring in 5% (n = 2) patients.
Conclusions
The minimally invasive free vascularized omental lymphatic flap provides a safe donor site, a durable and versatile flap, and an efficacious therapy against lymphedema and lymphedema-related cellulitis. J. Surg. Oncol. 2017;115:84–89. © 2016 Wiley Periodicals, Inc.
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