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Page 6 of 8 Danforth et al. Plast Aesthet Res 2021;8:48 https://dx.doi.org/10.20517/2347-9264.2021.34

Figure 1. (A) Mini-laparotomy incision for access. (B) Transillumination of proximal jejunum for visualization of vascular cascades and
lymph nodes. (C) Inset of jejunal mesenteric vascularized lymph node transfer (end to side to the radial artery; end to end venous
anastomosis).

We would not recommend relying on the appendiceal lymph node basin given these findings; however, if a
multilevel transfer is desired during a planned jejunal or omental VLNT, the mesoappendix could be easily
examined for the presence of a node and vessel caliber and then harvested if found to be suitable for
transfer. In our review of the literature, a single case report of appendiceal lymph node transfer to the lower
extremity has been published. The patient, in that case, did have a reduction in limb circumference (17.4%
above knee, 15.1% below knee, 12% above ankle, 9% foot) and no postoperative episodes of cellulitis at six
[20]
months .

CONCLUSIONS
The abdomen is a rich source of lymphatic tissue and provides multiple options for VLNT donor sites.
Intraperitoneal lymphatic donor sites completely avoid the dreaded complication of iatrogenic lymphedema
that is a risk of groin and axillary-based flaps; additionally, intraperitoneal operations result in well-hidden
scars. Multiple intraabdominal lymph node flaps can be harvested from a single incision, thus giving
surgeons more options for multilevel transfers or treatment of bilateral lymphedema. Currently, the
omental/gastroepiploic nodes are the most commonly transferred intraabdominal lymph nodes - likely due
to the familiarity of the omental harvest. Jejunal mesenteric VLNT has also been recently described with
promising results. Some surgeons may hesitate to use intraabdominal lymph nodes because of the risks of
an abdominal operation, including bowel injury and hernia. However, the existing studies demonstrate that
while surgeons and patients must be aware of risks, these operations can be performed with reasonably low
complication rates and do result in improvement of lymphedema.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception, structure, writing, and editing this review: Danforth R,
Skoracki R

Availability of date and materials
Not applicable.

Financial support and sponsorship
None.