Journal of the American College of Surgeons
Original scientific article
Vascularized Jejunal Mesenteric Lymph Node Transfer: A Novel Surgical Treatment for Extremity Lymphedema
Coriddi, Michelle MDa; Wee, Corrine BSa; Meyerson, Joseph MDa; Eiferman, Daniel MD, FACSb; Skoracki, Roman MD, FACSa,*
aDepartment of Plastic Surgery, The Ohio State University, Columbus, OH
bDepartment of General Surgery, The Ohio State University, Columbus, OH
email: [email protected]
Received July 8, 2017; Revised July 31, 2017; Accepted August 1, 2017.
Disclosure Information: Nothing to disclose.
*Correspondence address: Roman Skoracki, MD, FACS, The Department of Plastic Surgery, 915 Olentangy River Rd, Suite 2140, Columbus, OH 43212.
Presented at the American Society for Reconstructive Microsurgery Annual Meeting, Waikoloa Village, HI, January 2017.
BACKGROUND:
Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT.
STUDY DESIGN:
We performed a cadaveric anatomic study analyzing jejunal lymph nodes (LNs) and describe outcomes from the first patients who received jejunal mesenteric VLNT for treatment of lymphedema.
RESULTS:
In 5 cadavers, the average numbers of total LNs and peripheral LNs were identified in the proximal, middle, and distal segments of jejunum. Totals counted were 19.2/13.8/9.6, (SD 7.0/4.4/1.1), respectively; of those, 10.4/6.8/3.4 (SD 3.6/2.3/2.6), respectively, were in the periphery. There were significantly more total and peripheral lymph nodes in the proximal segment compared with the middle and distal segments (p = 0.027 and p = 0.008, respectively). The jejunal VLNT was used in 15 patients for treatment of upper (n = 8) or lower (n = 7) extremity lymphedema. Average follow-up was 9.1 (±6.4) months (range 1 to 19 months). Of 14 patients with viable flaps (93.3%), 12 had subjective improvement (87.5%). Ten patients had preoperative measurements, and of those, 7 had objective improvement in lymphedema (70%).
CONCLUSIONS:
The jejunal mesenteric VLNT is an excellent option for lymphedema treatment because there is no risk of donor site lymphedema or nerve damage, and the scar is easily concealed. Harvest from the periphery of the proximal jejunum is optimal. Improvement from lymphedema can be expected in a majority of patients.