Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for Breast Cancer-Related Lymphedema

Abstract

Background: The vascularized groin and submental lymph node (VGLN and VSLN) flaps are valuable options in the treatment of lymphedema. This study was to compare outcomes between VGLN and VSLN transfers for breast cancer-related lymphedema.

Methods: Between January 2008 and December 2016, VGLN and VSLN transfers for upper limb lymphedema were compared including flap characteristics, flap elevation time, complications, and limb circumference changes.

Results: All flaps survived. Similar vein (2.6 versus 3.2 mm; P = 0.3) and artery diameter (2.1 versus 2.8 mm; P = 0.3) and number of lymph nodes (3 versus 4; P = 0.4) were found between VGLN and VSLN groups, respectively. Circumferential reduction rate was higher in VSLN than VGLN (P = 0.04) group. Vascular complication rate with salvage rate was not statistically different between the 2 groups. Donor-site complication and total complication rates were statistically higher in VGLN than VSLN flaps (7.7% versus 0%, P = 0.004; 46.2% versus 23.3%, P = 0.002). At a mean 39.8 ± 22.4 months, the circumferential reduction rate was statistically higher in VSLN than in the VGLN group (55.5 ± 14.3% versus 48.4 ± 23.9%, P = 0.04). Both flaps were effectively decreased in the episodes of cellulitis.

Conclusions: Both VGLN and VSLN flaps are valuable surgical options in treating breast cancer-related lymphedema. However, the VSLN flap for breast cancer-related lymphedema is better in providing more significant improvements in limb circumference, a faster flap harvest time, decreased complication rates, and minimal donor-site iatrogenic lymphedema.

Fig. 1.

A 65-year-old woman who was a victim of right breast cancer postmastectomy, axillary lymph node dissection, and chemoradiation. She suffered from right upper limb lymphedema with 3 episodes of cellulitis per year for 2 years. She underwent right vascularized groin lymph node flap transfer to right dorsal wrist. Skin paddle 12 × 6 cm was designed on right groin below the inguinal ligament and close to common femoral vessels. One perforator was marked with pencil of medial Doppler (A). The superficial circumflex vessels were identified with vessel loop. The flap was elevated with short pedicle artery and 2 veins (C). The donor site of right groin 6 years after (D).

Fig. 2.

A 52-year-old woman suffered from breast cancer-related lymphedema on right upper limb for 4 years. A vascularized submental lymph node flap 8.5 × 2.2 cm was designed on right neck (A). Three sizable lymph nodes (yellow arrows) were noted on the divided flap (B). Two marginal mandibular nerves were well preserved under microscope (C). The donor site scar was inconspicuous 30 months postoperatively (D).

Fig. 3.

The preoperative front view of case 1 (A) and postoperative 48 months follow-up front view (B). The circumferential difference was improved from 52% to 18%.

Fig. 4.

The preoperative front view of case 2 (A) and postoperative 30 months follow-up front view (B). The circumferential difference was improved from 32% to 10%.