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outcomes and, in some instances, precluded any statistical analysis. Nevertheless, our study remains a
comprehensive systematic review of the current outcome-based research on VLNT and should encourage
future studies to standardize clinical staging, methodologies, and outcome measures.

CONCLUSION
VLNT is a promising treatment modality for many patients with lymphedema, which has previously been
thought to be a progressive, chronic disease. New donor sites, such as the omental, appendiceal, ileocecal,
and jejunal mesenteric, have offered possible advantages in mitigating the risk of donor-site lymphedema
for patients while overall resulting in a greater reduction in infectious episodes in comparison to extra-
abdominal donor sites. This warrants additional consideration in the literature. With more consistent
methodology and reporting, patient-reported outcomes and clinical outcomes could be better compared
between studies and offer more robust data to guide surgical practice in VLNT for lymphedema patients.

DECLARATIONS
Authors’ contributions
Initial literature search: Yaeger L
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Christensen JM, Raman S, Sanka SA, Ji J, Skolnick GB
Performed data acquisition, as well as provided substantial contributions to the manuscript: Raman S,
Sanka SA, Ji J
Provided significant guidance and feedback in manuscript editing process: Christensen JM, Skolnick GB

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not Applicable.

Consent for publication
Not Applicable.

Copyright
© The Author(s) 2023.

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