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J Reconstr Microsurg 2018; 34(07): 472-477
DOI: 10.1055/s-0038-1642637
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Omental Vascularized Lymph Node Flap: A Radiographic Analysis

Julia A. Cook
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Sarah E. Sasor
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Sunil S. Tholpady
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
2   Division of Plastic and Reconstructive Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
,
Michael W. Chu
3   Division of Plastic and Reconstructive Surgery, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
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Publikationsverlauf

01. Dezember 2017

18. Januar 2018

Publikationsdatum:
16. April 2018 (online)

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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.

Keywords

omental flap - vascularized lymph node transfer - lymphedema
 

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