Page 22 - Read Online

Friedman et al. Plast Aesthet Res 2022;9:58 Plastic and
DOI: 10.20517/2347-9264.2022.77
Aesthetic Research

Original Article Open Access

The Boston lymphatic center’s early experience with
lymph node transplantation to the upper extremity

1
1
1
1
1
2
Rosie Friedman , Monica Morgenstern , Valeria P. Bustos , Aaron Fleishman , Kathy Shillue , Leo L. Tsai ,
3
Jonathan F. Critchlow , Dhruv Singhal 1
1
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA 02215, USA.
2
Division of Magnetic Resonance Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA 02215, USA.
3
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Correspondence to: Dr. Dhruv Singhal, Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel
Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA 02215, USA. E-mail:
dsinghal@bidmc.harvard.edu
How to cite this article: Friedman R, Morgenstern M, Bustos VP, Fleishman A, Shillue K, Tsai LL, Critchlow JF, Singhal D. The
Boston lymphatic center’s early experience with lymph node transplantation to the upper extremity. Plast Aesthet Res 2022;9:58.
https://dx.doi.org/10.20517/2347-9264.2022.77
Received: 4 Jul 2022 First Decision: 9 Aug 2022 Revised: 2 Sep 2022 Accepted: 8 Oct 2022 Published: 13 Oct 2022
Academic Editor: Matthew Iorio Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
Aim: Although vascularized lymph node transplantation (VLNT) has gained recognition as an effective treatment
option for lymphedema, no consensus on the timing of transplant with other lymphatic procedures has been
established. The aim of this study is to describe our institutional experience with VLNT, including our staged
approach and report postoperative outcomes.
Methods: A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May
2017 to April 2022 was conducted. Patients were divided into fat- or fluid-dominant phenotypes based on
preoperative workup. Patients with a minimum of 12-month follow-up were included. Records were reviewed for
demographic, intraoperative, and surveillance data.

Results: Twenty-three patients underwent VLNT of the upper extremity during the study period, of which eighteen
met the study criteria. Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and
had undergone prior debulking at our institution. Fluid-dominant patients demonstrated slight reductions in limb
volume and hours in compression, and improvement in quality-of-life scores at twelve months. Fat-dominant

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net