Immediate Lymphatic Reconstruction (ILR) With Vascularized Omentum Lymphatic Transplant (VOLT)
Stav Brown, George Kokosis, Francis Graziano, Oriana Haran, Elizabeth Smith-Montes, Michelle Coriddi, Babak J. Mehrara, Joseph Dayan
Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, USA
Lymph node dissection often causes more disability than just lymphedema. While immediate lymphatic reconstruction (ILR) with lymphovenous bypass (LVB) is performed at the time of standard lymphadenectomies, in patients with overwhelming risk of developing contracture and lymphedema, it is Ideal is to reconstruct both soft tissue and lymphatic defect. The purpose of this study was to evaluate the safety and efficacy of ILR with a vascularized omentum lymphatic transplant (VOLT) to reduce the risk of contracture and lymphedema development in patients with extensive disease.
Patients with an overwhelming risk of developing severe lymphedema and contracture (bulky disease, extensive surgery and/or radiation, recurrence, reoperation), were offered VOLT at the time of axillary/groin dissection at a tertiary-cancer center between 2016 to 2021. Demographic data, volume measurements, QOL scores, cellulitis episodes, compression use, and range of motion were recorded.
A total of eleven patients, nine females (82%) and two males (18%), with an average age of 52.1 14.0 years, underwent immediate reconstruction with VOLT at the time of axillary (n=7, 64%) or groin (n=4, 36%) dissection. The mean BMI was 27.6 3.8 kg/m2. No intraoperative complications were observed (0%). The mean follow-up time was 22.0 months. Lymphedema, defined as volume differential > 10%/LDEX > 6.5 developed in one patient. All patients maintained full range of motion with no pain (n=11, 100%). Only one patient used a compression garment occasionally (9%). Additionally, patients did not appear "radiated" with a satisfactory cosmetic result.
This is the first study to report ILR with VOLT. VOLT is a safe and reliable option for immediate-reconstruction of the highest-risk patient group who are almost certain to develop not only lymphedema but severe contracture and functional disability. Therefore, the authors recommend the use of VOLT in patients undergoing either an extensive lymph node dissection or postoperative radiation.
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