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Friedman et al. Plast Aesthet Res 2022;9:58 https://dx.doi.org/10.20517/2347-9264.2022.77 Page 5 of 11

Table 1. Patient demographics, disease characteristics, and VLNT intraoperative variables stratified by lymphedema phenotype
Overall cohort Fluid-dominant Fat-dominant
n = 18 n = 9 n = 9
Baseline characteristics
Age at VLNT, yrs (mean ± sd) 57.1 ± 10.1 53.4 ± 9.1 60.8 ± 10.2
Sex, female (n, %) 17 (94) 8 (89) 9 (100)
Race (n, %)
White 17 (94) 8 (89) 9 (100)
Black or African American 1 (6) 1 (11) 0 (0)
[2]
BMI, kg/m (median, Q1-Q3) 30.2 (28.8-32.1) 30.4 (28.8-32.4) 29.5 (28.5-31.1)
Lymphedema characteristics
Lymphedema laterality (n, %)
Left side 8 (44) 5 (56) 3 (33)
Right side 10 (56) 4 (44) 6 (67)
Limb dominance (n, %)
Left 2 (11) 1 (11) 1 (11)
Right 14 (78) 7 (78) 7 (78)
Ambidextrous 2 (11) 1 (11) 1 (11)
Etiology of lymphedema (n, %)
Oncologic surgery 17 (94) 8 (89) 9 (100)
Non-oncologic surgery 1 (6) 1 (11) 0 (0)
Time from lymphedema diagnosis to VLNT evaluation, years (median, Q1-Q3) 4.2 (2-7.2) 2 (1-4) 8 (4.5-15)
Time from debulking lipectomy to VLNT, months (median, Q1-Q3) - - 19.4 (16.1-20.3)
Surgical characteristics
Flap weight, grams (median, Q1-Q3) 23 (17.5-28) 24 (15-29) 22 (18.8-28)
Recipient location (n, %)
Forearm 18 (100) 9 (100) 9 (100)
Flow-through technique utilized, yes (n, %) 15 (83) 6 (67) 9 (100)
No. lymph nodes identified by ultrasound (median, Q1-Q3) 6 (5-7) 6 (4-7) 6 (5-7)
VLNT: Vascularized lymph node transplantation.

years compared to the fat-dominant group at 8 (5-15) years. For lymphedema patients with fat-dominant
disease, the median time from debulking to VLNT was 18 (16-21) months. For all patients, the median flap
weight was 23 (18-28) grams with a median of 6 (5-7) lymph nodes transferred, as identified on
intraoperative ultrasound. All lymph node flaps were transferred to the forearm of the affected extremity.
Arterial configuration was flow-through in 83% (n = 15) of patients and end-to-side in 17% (n = 3) of
[23]
patients. Two venous anastomoses were routinely performed on all flaps. On postoperative day three, one
patient developed a right upper extremity hematoma at the operative site, requiring urgent evacuation. No
other postoperative complications were reported.

At twelve months postoperatively, the fluid-dominant group (n = 9) revealed a median limb volume change
of -2% (-4% to 2%) with a decrease in hours spent using compression therapy from 47 (1-106) to 4 (0-50)
hours per week [Table 2]. This cohort displayed an increase in L-Dex scores from 16 (12-36) to 31 (11-35)
and an improvement in all subdomains of LYMQOL at twelve months [Table 3]. Of note, two of the nine
patients in this group were able to discontinue compression therapy entirely at twelve months. Of the four
patients in this cohort that had postoperative MRI at twelve months, there was a noticeable improvement in
edema in 100% (n = 4) of patients, and the lymph node flap was viable in 100% (n = 4) of the studies
[Figure 2].