Combined deep inferior epigastric artery perforator flap with vascularized groin lymph node transplant for treatment of breast cancer-related lymphedema
Mark V. Schaverien, Edward I. Chang
Abstract
Around 3.5 million women in the United States are survivors of breast cancer, with almost 270,000 new cases diagnosed annually (1). Breast cancer-related lymphedema (BCRL) remains the greatest cancer survivorship burden for breast cancer survivors (2-5), affecting around 30% of patients treated for breast cancer (6), and all survivors remain at risk of developing clinical lymphedema over their lifetime Modern surgical techniques have demonstrated effectiveness at decreasing the symptoms of lymphedema, reducing the risk of future infections, decreasing the amount of time spent daily for lymphedema care and improving quality of life (8-13). These procedures can be broadly categorized as physiological or debulking. Physiological procedures, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), aim to restore lymphatic fluid drainage within the affected extremity (14-19). The VLNT procedure is indicated in advanced stage lymphedema and involves microvascular anastomosis to perfuse and maintain function of the lymph nodes transplanted into an extremity, either to an anatomical (orthotopic) or non-anatomical (heterotopic) location, to restore physiological lymphatic function Orthotopic VLNT has the additional advantage of the opportunity for radical axillary scar release/ lysis to allow drainage from the affected extremity, relieve restrictions to upper extremity range of motion, create a recipient bed for the lymph node flap, and in cases of venous insufficiency decompress the axillary/subclavian vein.