Decreasing donor site morbidity after groin vascularized lymph node transfer with lessons learned from a 12-year experience and review of the literature

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Abstract

Introduction: Donor site morbidity related to vascularized lymph node transfer (VLNT) remains a cause of worry among surgeons. As such, our study explores donor site morbidity after VLNT with or without concomitant deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Furthermore, we evaluate our surgical approach to ascertain whether it reduces the morbidity rate. Materials and methods: A retrospective chart review of donor site complications and surgical techniques was performed from 2006 to 2018. The patients’ medical histories and demographic data were analyzed for risk factors. Patients were contacted by telephone for a long-term follow-up questionnaire. A literature review was implemented to evaluate the reported donor site complications and surgical strategies in literature. Complications were evaluated with and without concomitant autologous breast reconstruction (DIEP flap). Results: Eighty-nine patients were included in our case series. Sixty-five cases (73%) were combined with DIEP flap breast reconstruction. Seroma rate diminished from 60% in the first 39 cases to 18% in the last five years (50 cases) (p < 0,001). Lymphedema of the afferent lower limb is described in the literature but did not occur in our series. Conclusions: Seroma formation is the most common donor site morbidity after groin VLNT flap harvest, particularly when combined with DIEP flap breast reconstruction. This paper contains the largest reported series of combined VLNT + DIEP flaps and describes surgical strategies on how to decrease seroma formation and avoid iatrogenic lymphedema of the lower limb.

Original languageEnglish
Pages (from-to)540-548
Number of pages9
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume74
Issue number3
Early online date2020
DOIs
Publication statusPublished - Mar 2021

Bibliographical note

Copyright © 2020 Elsevier Ltd. All rights reserved.

Keywords

  • Donor site morbidity
  • Lymphedema
  • Microsurgery
  • Plastic surgery
  • Reconstructive surgery
  • Vascularized lymph node transfer

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