Immediate Lymphatic Reconstruction with Vascularized Omentum Lymph Node Transplant: Reducing the Risk of Both Painful Contracture and Lymphedema

In a groundbreaking study published in Plastic and Reconstructive Surgery Global Open, Dayan et al. present a novel technique that could revolutionize the management of high-risk patients undergoing extensive lymphadenectomy. The procedure, known as Immediate Lymphatic Reconstruction (ILR) with Vascularized Omentum Lymphatic Transplant (VOLT), shows promise in mitigating two significant post-operative complications: lymphedema and painful contracture.

Methodology and Patient Cohort

The study included 13 patients (11 female, 2 male) with a mean age of 54.9 years and an average BMI of 26.0 kg/m². These patients, deemed high-risk due to factors such as bulky disease, recurrence, or prior radiotherapy, underwent ILR with VOLT during axillary (n=8) or inguinal (n=5) lymphadenectomy.

The VOLT procedure involved harvesting the omentum as a free flap and transplanting it to the axilla or groin concurrent with nodal dissection. This technique not only addresses lymphatic reconstruction but also provides crucial soft tissue replacement.

Key Findings

With a mean follow-up of 15.1 months, the results are remarkably promising:

1. Only one patient developed mild lymphedema (11% volume differential)
2. All patients maintained full range of motion without pain
3. No patients required compression garments
4. Satisfactory cosmetic outcomes were achieved, avoiding the typical "hollowed-out" appearance

Implications for Clinical Practice

This innovative approach offers several advantages over traditional lymphovenous bypass techniques:

• Provides soft tissue replacement, reducing the risk of adhesions and contracture
• It may be feasible in cases where lymphovenous bypass is technically challenging
• Addresses both lymphatic and soft tissue deficits simultaneously

While longer-term follow-up and prospective studies are needed, these initial results suggest that ILR with VOLT could be a game-changer for high-risk patients facing extensive lymph node dissection and adjuvant radiotherapy.

We encourage you to read the full study for a detailed review of the technique and outcomes.

As we continue to advance our understanding of post-lymphadenectomy complications, techniques like ILR with VOLT offer new hope for improving patient outcomes and quality of life. We look forward to seeing further research in this promising area of reconstructive surgery.