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Beederman et al. Plast Aesthet Res 2022;9:54 https://dx.doi.org/10.20517/2347-9264.2022.64 Page 5 of 7

[11]
Figure 4. The Supraclavicular lymph node transplant should be isolated on its pedicle and ready for ligation and division .
Once the flap has been transferred to its recipient site location, the donor site can be closed. Adequate
hemostasis is obtained, although with the above technique, the field should be relatively bloodless. A single,
closed-suction drain is placed, exiting the skin laterally and ensuring that there is no suction near the IJV.
The wound is closed in layers - the platysma with interrupted absorbable sutures and the skin with a
running subcuticular suture. Because we routinely harvest the SC lymph nodes without a skin paddle, an
implantable Doppler around the arterial anastomosis is typically used for flap monitoring for 72 h .
[14]
DISCUSSION
While first described by the senior author in 2013 for use in the treatment of lower extremity
[15]
lymphedema , the supraclavicular lymph node flap has become our common choice donor site for both
upper and lower extremity lymphedema in patients who have minimal soft tissue deficits at the recipient
site. The benefits of this donor site are many, including no risk for facial nerve damage (as is the case with
submental lymph node harvest), an easily concealed scar, and a relatively quick harvest with the use of
proper technique and knowledge of anatomy. Our group has prospectively examined the aesthetic
outcomes-related SC VLNT donor site scarring. The results show that the SC VLNT scar, while visible, is
well-accepted by both patients and surgeons alike, with almost 77% of patients stating that they were “very
satisfied” with the appearance of their scar (unpublished data).

The risks of SC VLNT harvest include bleeding, as the operative space can be small and deep, chyle leaks,
and potential damage to the phrenic nerve and other important structures in the operative field. While not a
downside, it is again important to reiterate that the vascular anatomy of the supraclavicular lymph nodes
can be variable; therefore, it is important to pay close attention during dissection to prevent inadvertent
damage to the flap’s vascularity.

A terrible complication of VLNT is the occurrence of donor site lymphedema. Although a previous case
report has documented the occurrence of upper extremity lymphedema following SC VLNT harvest , we
[16]
have not found this to be the case in our patient population. In a previous study looking at a group of 100
consecutively treated patients who underwent SC VLNT to either the upper or lower extremity by our
senior author, no instances of donor site lymphedema were reported . The importance of a thorough
[17]
understanding of the anatomy of this region in avoiding iatrogenic lymphedema cannot be overstated.