Use of Magnetic Resonance Angiography to Better Define the Supraclavicular Lymph Node Flap
Catherine S. Chang, MD, Jillian Lazor, MD, Jonathan Bank, MD, Patrick Gerety, MD, Joel Stein, MD, Suhail S. Kanchwala, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: The ideal donor site for vascularized lymph node transfer(VLNT) is one that is easily accessible, has little risk of donor site lymphedema, sufficient nodes and pedicle length, and a concealable scar. The supraclavicular(SC) LN flap meets all of these requirements, however has not yet achieved popularity due to concern over its reliable anatomy and sufficient number of lymph nodes. We use magnetic resonance angiography(MRA) to delineate number, size, and location of SC nodes in reference to the transverse cervical artery(TCA).
Methods: A retrospective review of neck MRAs performed at our institution from January-September 2014 was performed. 30 studies met inclusion criteria. The right TCA was identified and the diameter at its origin measured. Size and distance of SC nodes in three dimensions in relation to the TCA origin were measured.
Results: A total of 142 lymph nodes were identified with an average of 4.7±2.2 nodes per patient and mean length of 5.3±2mm. Average diameter at the TCA origin measured 2.7±0.8mm. With respect to the TCA origin, all nodes were lateral, 96% superior, and 78% posterior. Average distance from the TCA origin was 37±13 mm, with nodes 19.2±11.8 mm superior, 27.7±11.3mm lateral, and 23.1±11.8mm posterior to TCA origin. 23% of patients had a separate origin of the TCA from the subclavian artery.
Conclusion: The SCLN flap is ideal for VLNT. MRA demonstrates sufficient and consistent number of nodes to be transferred, better delineates the anatomy of this flap, as well as provides useful guidelines for identifying targeted nodes more efficiently.
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