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Danforth et al. Plast Aesthet Res 2021;8:48 https://dx.doi.org/10.20517/2347-9264.2021.34 Page 3 of 8

Table 1. Summary of available intra-abdominal donor sites for VLNT

Lymph node donor Donor characteristics Clinical studies * Outcomes reported Mean follow-up
site (months)
[13]
Omentum/Gastroepiploic - Versatile Nguyen et al. (2017): 42 patients, laparoscopic Mean volume reduction = 22% 14
- Familiar harvest harvest Subjective improvement in 83%
- Most commonly used intra-abdominal Rate of cellulitis: 74% of patients pre-op to 5% post-op
site Ciudad et al. [16] (2017): 10 patients, laparoscopic right Mean CRR = 39.5% 14.7
- Multi-level transfer possible gastroepiploic VLNT Improved LYMQOL scores
- Access via mini-laparotomy,
[16]
laparoscopic, or robotic Ciudad et al. (2017): 7 patients, double level Mean CRR = 43.7% 9.7
- May be unavailable after previous gastroepiploic VLNT
surgery/if adhesions present Maruccia et al. [17] (2019): 16 patients, double level Mean CRR = 58.3% below knee, 43.4% above knee at 12 months 26.2
- Perfusion should be verified (with ICG)
gastroepiploic VLNT Improved LYMQOL score
[18]
Ciudad et al. (2019): 16 patients, double Mean CRR= 74.5% for upper, 68% for lower 14.2
gastroepiploic VLNT + excisional procedure Improved LYMQOL scores
[15]
Manrique et al. (2020): 13 patients with distally Mean volume reduction = 6
inset omental VLNT; 13 w/ mid-limb inset Upper extremity: mid 23.3%, distal 22%
Lower extremity: mid 23.3%, distal 13.3%
[9]
Ciudad et al. (2020): 6 patients gastroepiploic Mean CRR = 30% 12.8
VLNT + DIEP breast reconstruction
[19]
Jejunal mesenteric - Consistent presence of nodes Coriddi et al. (2017): 14 patients, 15 VLNT Mean reduction in extremity lymphedema index = 5.4% at 1 9.1
- Multi-level transfer possible month; 12/14 (87.5%) patients with symptomatic relief
- Access via mini-laparotomy
- Small volume, ideal for distal
extremities
- Remains reliable after previous
abdominal surgery
- Must be aware of bowel perfusion
[20]
Appendiceal - Expendable donor Ciudad et al. (2018): appendiceal VLNT case CRR = 17.4% above knee, 15.1% below knee, 12% above ankle, 6
- Laparoscopic or open harvest report 9% foot
- Presence of lymph node rare (8%) No postoperative cellulitis
- Small caliber vessels

*Clinical studies reporting quantitative limb measurement outcomes were included in this table. All share the benefits of hidden scar, no risk of iatrogenic lymphedema, and the ability to combine procedures. CRR:
Circumference reduction rate; VLNT: vascularized lymph node transfer.

VLNT are available and can be tailored to the recipient limb needs. The entirety of the omentum can be harvested and transferred. The volume and large

surface area of the omental free tissue transfer can be very beneficial in certain locations, such as the axilla after lymphadenectomy or if there is an associated
wound needing soft tissue coverage .
[22]