Laparoscopic Free Omental Lymphatic Flap for the Treatment of Lymphedema
Alexander T. Nguyen, M.D., Hiroo Suami, M.D., Ph.D..
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Advances in microsurgery have displayed promising results in the treatment of lymphedema. Currently utilized vascularized lymph node transfers incur the risk for donor site lymphedema. The pedicled omentum has been previously described for the treatment of lymphedema but has been overlooked due to presumed high morbidity. We present the technique and early results of the laparoscopic free omental lymphatic flap (LOLF) for the treatment of lymphedema.
Laparoscopic free omental lymphatic flap harvest was performed and transplanted in patients with recalcitrant and severe upper extremity lymphedema secondary to breast cancer treatment. Postoperative evaluation included qualitative assessment and quantitative analysis.
Two patients underwent successful LOLF to the affected upper extremity. Patient demographics included an average age of 50 years old, BMI of 38, and 4.2 year duration of lymphedema. Both patients had previous episode of lymphangitis requiring admissions for intravenous antibiotics. Average flap harvest time was 103 minutes. No donor or recipient site complications were encountered. Average follow up is 10.7 months. Both patients report subjective improvement to the affected extremity. Tape measurements at defined landmarks displayed an average improvement of 19 and 9% in each patient. Lymphograms at 6 months support omental lymphatic flap functionality.
The laparoscopic free omental lymphatic flap (LOLF) is a novel microsurgical approach to the management of lymphedema with potentially enhanced outcomes and donor site morbidity when compared to previously published options. Long-term studies and follow-up will further identify the safety and efficacy of this flap option for lymphedema.
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