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Page 2 of 7 Beederman et al. Plast Aesthet Res 2022;9:54 https://dx.doi.org/10.20517/2347-9264.2022.64

system and lymph nodes exists, or if once normal lymphatic vessels and nodes have been subsequently
damaged or disrupted. In the developed world, this is most often due to oncologic treatments
(lymphadenectomy and/or radiation in the groin or axilla) or trauma.

Nonsurgical management of lymphedema remains the first-line treatment option for both upper and lower
extremity primary and secondary lymphedema. This can include manual drainage techniques, compression
garment and pneumatic pump use, skin care optimization, exercise therapy, and patient education.
Complete decongestive therapy uses a combination of all the above modalities, often requiring lifelong
effort and extensive daily commitment for patients to maintain results and prevent disease progression.

Surgical interventions are becoming an increasingly popular option for patients, especially those who fail or
have suboptimal results from nonsurgical management. Patients may undergo ablative surgery, including
liposuction and direct excision. While ablative surgeries are effective in decreasing the volume of the
affected limb by removing edematous tissue, they do not correct the underlying problem: damaged or
absent lymphatic channels. Nevertheless, these damaged lymphatic channels and drainage systems can be
augmented through physiologic surgery. These physiologic surgical interventions include vascularized
lymph node transplant (VLNT) and lymphovenous bypass (LVB), performed either separately or in
combination .
[1,2]

Vascularized lymph node transplant involves the transfer of vascularized lymph nodes from a donor site to
a site either proximally or distally on the affected extremity. Lymph node donor sites include the
supraclavicular region (SC), the submental region, the superficial groin, the lateral thoracic/axillary region,
and various intraabdominal sites, such as the omentum. Each of these donor sites has its own benefits and
risks, which have been widely reported . To date, there has not been any conclusive evidence about which
[3,4]
donor site is optimal, and much of the decision-making involves surgeon and patient preference, as well as
donor site availability and clinical assessment of the lymphedematous limb . While the exact mechanism
[5-7]
of action of VLNT remains to be elucidated, there have been several proposed theories regarding the
physiology behind how these transplanted lymph nodes function to improve lymphedema by promoting
local lymphangiogenesis and acting to create spontaneous lympholymphatic anastomoses at the affected
site, by acting like a “pump” through the removal and redirection of excess lymphatic fluid to the venous
system, or (more likely) a combination of the two [8-10] .

The aim of this paper is to describe our technique for the harvest of vascularized lymph nodes from the
supraclavicular area, which is our preferred donor lymph node harvest site. As our senior author has
[11]
previously published , the successful harvest of supraclavicular lymph nodes requires a thorough
understanding of the local anatomy and the critical structures near the operative field, including the carotid
artery, the internal jugular vein, and the phrenic nerve. We will also briefly discuss our experience and
results from the use of this donor site.

ANATOMY
The supraclavicular lymph nodes are reliably located within an anatomic triangle whose borders are
comprised of the dorsal edge of the sternocleidomastoid muscle (SCM) medially, the external jugular vein
(EJV) laterally and the medial part of the clavicle inferiorly. The SC lymph nodes can be harvested with or
without a skin paddle, depending on soft tissue needs at the recipient site. When harvested with a skin
paddle, the blood supply comes from the supraclavicular artery, which arises from the transverse cervical
artery (TCA). Venous drainage is through accompanying veins, which drain either into the transverse
cervical vein (TCV) or the external jugular vein. Without a skin paddle, the blood supply to the flap can be