Quantifying Lymph Nodes During Lymph Node Transplantation:The Role of Intra-operative Ultrasound
Bao Ngoc Tran, M.D., Arthur Celestin,, MD, Bernard T. Lee, MD, MPH, MBA, Dhruv Singhal, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: Quantifying lymph nodes in vascularized lymph node transfer (VLNT) has been performed utilizing pre-operative percutaneous ultrasound. We hypothesize that intra-operative ultrasound (IOU) during VLNT would be a superior method to quantify and map lymph nodes in our flaps.
METHODS: A prospectively collected database of patients undergoing VLNT over three years 2014-2017 was reviewed. Patients who underwent IOUS during flap harvest, prior to pedicle ligation, to simultaneously map and quantify the number of lymph nodes were included in the study.
RESULTS: Twenty-one patients with an average age of 58.7 years and a mean BMI 32.3 underwent VLNT with IOUS for chronic lymphedema during the study period. Extremity lymphedema was classified as Campisi IB (n=7), IIA (n=7), IIB (n=5), and IIIA (n=2). There were 14 superficial circumflex iliac artery (SCIA) flaps, including 4 performed concomitantly with deep inferior epigastric perforator (DIEP) flaps, 1 transverse cervical artery (TCA) flap, and 6 omental flaps. The average number of lymph nodes transferred per IOUS was 4.3 for SCIA flaps, 4 for the TCA flap, and 5.2 for the omental flap.
CONCLUSION: IOUS allows for precise mapping of lymph nodes location which can guide intra-operative decision making. While the number of lymph nodes observed for SCIA flaps is comparable to prior studies, our single TCA flap demonstrated a larger number of nodes than previously reported. As there is no data correlating the number of lymph nodes transferred and outcomes following VLNT, developing a precise intra-operative quantification method is important.
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