Page 50 - Read Online

Tawaklna et al. Plast Aesthet Res 2023;10:63 Plastic and
DOI: 10.20517/2347-9264.2023.40
Aesthetic Research

Perspective Open Access

Lower extremity lymphedema and vascularized
lymph node transfer recipient sites: a review of the

current literature

Kenan Tawaklna, David Chi , Jordan G. Bruce, Austin Y. Ha, Rachel Anolik
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110,
USA.

Correspondence to: Dr. Rachel Anolik, Division of Plastic and Reconstructive Surgery, Department of Surgery, 660 S. Euclid, 1150
Northwest Tower, Box 8238, Washington University in St. Louis, St. Louis, MO 63110, USA. E-mail: Anolik.R@wustl.edu

How to cite this article: Tawaklna K, Chi D, Bruce JG, Ha AY, Anolik R. Lower extremity lymphedema and vascularized lymph
node transfer recipient sites: a review of the current literature. Plast Aesthet Res 2023;10:63. https://dx.doi.org/10.20517/2347-
9264.2023.40
Received: 1 May 2023 First Decision: 21 Sep 2023 Revised: 13 Oct 2023 Accepted: 6 Nov 2023 Published: 14 Nov 2023

Academic Editors: Isao Koshima, Nicole Lindenblatt Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring
physiological lymphatic flow. Much variation exists in determining the appropriate donor site from which to harvest
lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes. This article reviews the
underlying principles of free vascularized lymph node transfer and discusses patient-specific, disease-specific and
surgery-specific factors in considering recipient sites from the proximal, middle, and distal lower extremity. The
clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented. An
omental flap to the middle lower extremity (mid-thigh, popliteal fossa, or medial calf) is then recommended due to
the abundance of lymphatic tissue, proximity to pooled lymph fluid, and avoidance of added bulk or poor cosmesis
of the distal lower extremity. However, additional clinical outcomes studies are needed and represent an area of
further investigation.

Keywords: Lower extremity lymphedema, vascularized lymph node transfer, physiologic procedure, lymph node
flap, lymphatic flap, lymph node donor, lymph node recipient, lymphangiogenesis

© The Author(s) 2023. 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.oaepublish.com/par