What is a Vascularized Lymph Node Transfer?
A Vascularized Lymph Node Transfer (VLNTx) is a microsurgical procedure where lymph nodes are transferred from a low-risk lymph node basin, to a limb with symptomatic lymphedema. It is a procedure where a lymph node "flap" with an associated artery and vein is harvested, either alone or in connection with a DIEP flap. The flap is subsequently transferred to either the axilla or groin after scar tissue has been removed from the associated neurovascular structures of the recipient site. Blood flow is re-established to the lymph node flap by reattaching the blood vessels of the flap to the blood vessels found in the recipient site using the magnification provided by an operating room microscope.
Patients with leg lymphedema may require VLNTx at the level of the knee and groin, whereby arm lymphedema is commonly treated only with one transfer at the level of the axilla. Patients with profound soft tissue deformities may require excision of excess skin and liposuction of the extremity in a staged fashion.
Patients resume manual lymphatic massage and compression garments/bandaging post-operatively. An improvement in soft tissue swelling can be seen in most patients. Patients relate a decrease in limb circumference, decreased pain, and fewer soft tissue infections.
