Faculty Collaboration Database

Omental Vascularized Lymph Node Flap: A Radiographic Analysis. J Reconstr Microsurg 2018 Sep;34(7):472-477

Date

04/17/2018

Pubmed ID

29660745

DOI

10.1055/s-0038-1642637

Scopus ID

2-s2.0-85045677609 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND:  Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest.

METHODS:  Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA.

RESULTS:  In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups.

CONCLUSION:  The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap.

Author List

Cook JA, Sasor SE, Tholpady SS, Chu MW

Author

Sarah E. Sasor MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Computed Tomography Angiography
Female
Humans
Lymph Nodes
Lymphedema
Male
Middle Aged
Omentum
Surgical Flaps
Tissue and Organ Harvesting