The Use of Magnetic Resonance Angiography in Vascularized Groin Lymph Node Transfer: An Anatomic Study

Abstract

Vascularized groin lymph node transfer (VGLNT) has been successfully used to treat lymphedema. However, lack of familiarity with the inguinal node anatomy and concerns regarding donor site morbidity have limited its widespread use. The purpose of this study was to use magnetic resonance angiography (MRA) to clarify the inguinal anatomy and provide a reliable method for identifying the location of the superficial transverse inguinal lymph nodes. In this study MRA was used to evaluate the superficial inguinal lymph nodes in 117 patients. Coordinates of lymph nodes were plotted relative to an axis from the anterior superior iliac spine (ASIS) to the pubic tubercle (PT). The nodes were also plotted relative to the superficial circumflex iliac vein (SCIV) and superficial inferior epigastric vein (SIEV). A total of 1,938 lymph nodes were identified. These lymph nodes were concentrated on one-third the distance from the PT toward the ASIS and 3 cm perpendicularly below this line. About 67% of the superficial inguinal nodes were located within the bifurcation of the SIEV and SCIV. The results from this study provide useful guidelines for locating lymph nodes targeted for VGLNT.

Keywords

vascularized lymph node transfer - magnetic resonance angiography - lymphedema - lymphatic anatomy - superficial circumflex iliac artery - groin flap

• References

• 1 Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G. Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer 2001; 92 (7) 1783-1787
• 2 Kornblith AB, Herndon II JE, Weiss RB , et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 2003; 98 (4) 679-689
• 3 Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg 2004; 187 (1) 69-72
• 4 Schünemann H, Willich N. Lymphoedema of the arm after primary treatment of breast cancer. Anticancer Res 1998; 18 (3C) 2235-2236
• 5 Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 2006; 243 (3) 313-315
• 6 Becker C, Hidden G. Transfert de lambeaux lymphatiques libres. Microchirurgie et étude anatomique [Article in French]. J Mal Vasc 1988; 13 (2) 119-122
• 7 Lin CH, Ali R, Chen SC , et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg 2009; 123 (4) 1265-1275
• 8 Viitanen TP, Mäki MT, Seppänen MP, Suominen EA, Saaristo AM. Donor-site lymphatic function after microvascular lymph node transfer. Plast Reconstr Surg 2012; 130 (6) 1246-1253
• 9 Penha TR, Ijsbrandy C, Hendrix NA , et al. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review. J Reconstr Microsurg 2013; 29 (2) 99-106
• 10 Tobbia D, Semple J, Baker A, Dumont D, Johnston M. Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema. Plast Reconstr Surg 2009; 124 (3) 777-786
• 11 Vinnicombe SJ, Norman AR, Nicolson V, Husband JE. Normal pelvic lymph nodes: evaluation with CT after bipedal lymphangiography. Radiology 1995; 194 (2) 349-355
• 12 Vignes S, Blanchard M, Yannoutsos A, Arrault M. Complications of autologous lymph-node transplantation for limb lymphoedema. Eur J Vasc Endovasc Surg 2013; 45 (5) 516-520
• 13 Mathes DW, Neligan PC. Preoperative imaging techniques for perforator selection in abdomen-based microsurgical breast reconstruction. Clin Plast Surg 2010; 37 (4) 581-591, xi
• 14 Mathes DW, Neligan PC. Current techniques in preoperative imaging for abdomen-based perforator flap microsurgical breast reconstruction. J Reconstr Microsurg 2010; 26 (1) 3-10
• 15 Chen HC, O'Brien BM, Rogers IW, Pribaz JJ, Eaton CJ. Lymph node transfer for the treatment of obstructive lymphoedema in the canine model. Br J Plast Surg 1990; 43 (5) 578-586
• 16 Clodius L, Smith PJ, Bruna J, Serafin D. The lymphatics of the groin flap. Ann Plast Surg 1982; 9 (6) 447-458
• 17 Assouad J, Becker C, Hidden G, Riquet M. The cutaneo-lymph node flap of the superficial circumflex artery. Surg Radiol Anat 2002; 24 (2) 87-90
• 18 Gharb BB, Rampazzo A, Spanio di Spilimbergo S, Xu ES, Chung KP, Chen HC. Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema. Ann Plast Surg 2011; 67 (6) 589-593
• 19 Tammela T, Saaristo A, Holopainen T , et al. Therapeutic differentiation and maturation of lymphatic vessels after lymph node dissection and transplantation. Nat Med 2007; 13 (12) 1458-1466
• 20 Boneti C, Korourian S, Bland K , et al. Axillary reverse mapping: mapping and preserving arm lymphatics may be important in preventing lymphedema during sentinel lymph node biopsy. J Am Coll Surg 2008; 206 (5) 1038-1042 , discussion 1042–1044
• 21 Klimberg VS. A new concept toward the prevention of lymphedema: axillary reverse mapping. J Surg Oncol 2008; 97 (7) 563-564
• 22 Thompson M, Korourian S, Henry-Tillman R , et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol 2007; 14 (6) 1890-1895