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. 2021 Aug;4(4):e1370.
doi: 10.1002/cnr2.1370. Epub 2021 Apr 7.

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

Nicholas R Jarvis  1 , Ricardo A Torres  2 , Francisco R Avila  2 , Antonio J Forte  2 , Alanna M Rebecca  3 , Chad M Teven  3
Affiliations

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

Nicholas R Jarvis et al. Cancer Rep (Hoboken). 2021 Aug.

Abstract

Background: Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain.

Aim: To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods.

Methods and results: A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment.

Conclusion: This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.

Keywords: lymphedema; microsurgery; omental flap; upper extremity; vascularized omental lymphatic transplant.

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Conflict of interest statement

The authors report no conflicts of interest with respect to this work.

Figures

FIGURE 1
FIGURE 1
A, Tissue swelling due to lymphedema. B, The lymphatic system's capacity is exceeded, causing accumulation of fluid in the interstitium, which promotes the deposition of collagen and the proliferation of adipocytes around the capillary and collecting lymphatics
FIGURE 2
FIGURE 2
A, Healthy nodes en bloc and blood vessels from the omentum are B, transferred to the recipient site. C, Using microsurgery techniques, the blood vessels are anastomosed to the recipient site
FIGURE 3
FIGURE 3
PRISMA Flowchart depicting search schema (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses)
FIGURE 4
FIGURE 4
The vascularized omentum transfer acts as a “pump,” draining the fluid trapped in the interstitium to the venous system through a connection between the flap and the patient's recipient vein, alleviating the swelling
See this image and copyright information in PMC

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