Long-term Prospective Safety And Efficacy Of Vascularized Lymph Node Transplant (VLNT)
Stav Brown, MD, Michelle Coriddi, MD, Leslie McGrath, NP, Michele Cavali, BA, Ethan Plotsker, BS, Babak Mehrara, MD, Joseph Dayan, MD.
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Despite the increasing popularity of vascularized lymph node transplant (VLNT), there is lack of prospective long-term outcomes data and standardized outcome metrics, specifically following Vascularized Omentum Lymphatic Transplant (VOLT). The purpose of this IRB-approved prospective study was to evaluate the long-term outcomes of VLNT using a comprehensive set of outcome measures.
METHODS: All patients underwent VLNT at our institution between November 2014 and July 2020. Demographic data, volume measurements, bio-impedance scores, Quality of Life scores and cellulitis episodes were recorded.
RESULTS: A total of 89 patients with a mean follow-up time of 23.7±12 months were included. Donor sites consisted of the omentum (73%), axilla (13%), supraclavicular (7%), groin (3.5%), and others. 20% decrease (p=0.0239) in volume differential, and 27.5% decrease (p=0.0398) in L-DEX scores were recorded 2 years after VLNT. A significant improvement in Lymphedema Life Impact Scale (LLIS) scores manifested as 28.4% decrease (p=0.0398) was recorded 2 years after treatment. In addition, VLNT dramatically decreased the total number of cellulitis episodes by 93% (p=0.0008) 1 year after treatment as well as the average number of episodes per year (84.5% decrease, p=0.0002). No cases of donor site lymphedema were recorded (0%).
CONCLUSION: This prospective study demonstrated satisfactory reduction in limb volume, bioimpedance, and improved quality of life. This is the largest long-term prospective study of VOLTs in comparison to most studies evaluating peripheral VLNT. VOLT is a reliable alternative to peripheral VLNT with no risk of donor site lymphedema and particularly significant impact in reducing the incidence of cellulitis.
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