Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
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.
['Nguyen|Alexander T|AT|', 'Suami|Hiroo|H|', 'Hanasono|Matthew M|MM|', 'Womack|Veda A|VA|', 'Wong|Franklin C|FC|', 'Chang|Edward I|EI|']
D000293:Adolescent D000328:Adult D000368:Aged D005260:Female D058752:Free Tissue Flaps D006801:Humans D008198:Lymph Nodes D008209:Lymphedema D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D009852:Omentum D016896:Treatment Outcome D055815:Young Adult
lymphedema LVA LVB VLNT lymphatic surgery lymphovenous anastomosis lymphovenous bypass vascularized lymph node transfer