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Hosomi et al. Plast Aesthet Res 2023;10:60 Plastic and
DOI: 10.20517/2347-9264.2023.77
Aesthetic Research

Case Report Open Access

Vascularized lymph node transfer with efferent
lymphatico-lymphatic anastomosis for treatment of

upper extremity lymphedema

1
Kento Hosomi 1 , Chihena H. Banda 1,2 , Makoto Shiraishi 1,3 , Kohei Mitsui , Ryohei Ishiura 1 , Kanako
1
Danno , Mitsunaga Narushima 1
1
Department of Plastic and Reconstructive Surgery, Mie university, Tsu 514-8507, Japan.
2
Plastic and Reconstructive Surgery Unit, Department of Surgery, The University Teaching Hospital, Lusaka 50110, Zambia.
3
Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan.
Correspondence to: Dr. Kento Hosomi, Department of Plastic and Reconstructive Surgery, Mie University, Edobashi 2-174, Mie,
Tsu city 514-8507, Japan. E-mail: kentohosomi@med.mie-u.ac.jp

How to cite this article: Hosomi K, Banda CH, Shiraishi M, Mitsui K, Ishiura R, Danno K, Narushima M. Vascularized lymph node
transfer with efferent lymphatico-lymphatic anastomosis for treatment of upper extremity lymphedema. Plast Aesthet Res
2023;10:60. https://dx.doi.org/10.20517/2347-9264.2023.77

Received: 3 Aug 2023 First Decision: 12 Sep 2023 Revised: 25 Sep 2023 Accepted: 16 Oct 2023 Published: 24 Oct 2023

Academic Editor: Hiroo Suami Copy Editor: Dan Zhang Production Editor: Dan Zhang

Abstract
Vascularized lymph node transfers (VLNT) are useful options for the surgical treatment of lymphedema.
Conventional VLNT does not include the reconstruction of physiological lymphatic outflow, which may pose a risk
of postoperative lymphatic vessel obstruction and lymph node sclerosis. We report a case of lymph flow bypass
reconstruction using a superficial circumflex Iliac artery perforator (SCIP) flap, including VLNT with efferent
lymphatico-lymphatic anastomosis. A 63-year-old female with severe right upper extremity lymphedema after
mastectomy was reconstructed using a SCIP free flap, which included a vascularized lymph node elevated from the
left groin area and transferred to the right axilla area. The SCIP vessels were anastomosed to the medial intercostal
artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to
the internal mammary lymphatic vessels using supermicrosurgical technique. Indocyanine green lymphography
showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through
the transferred flap. Postoperatively, lymphedema improved and there was no lymphedema at the donor site with a
2-year follow-up. Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic
anastomosis may provide a useful option for the treatment of severe lymphedema.

Keywords: Lymph tissue transplantation, upper extremity lymphedema, vascularized lymph node transplantation

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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