Long-term Prospective Safety and Efficacy of Vascularized Lymph Node Transplant (VLNT)
Stav Brown, Leslie McGrath, Michele Cavalli, michelle coriddi, Babak J. Mehrara, Joseph Dayan
Plastic and Reconstructive Surgery , Memorial Sloan Kettering Cancer Center, New York , New York, United States
Purpose: Despite the increasing popularity of vascularized lymph node transplant (VLNT), there is a lack of prospective long-term outcomes data and standardized outcome metrics, specifically following Vascularized Omentum Lymphatic Transplant (VOLT). The purpose of this IRB-approved prospective study was to evaluate the long-term outcomes of VLNT using a comprehensive set of outcome measures.
Methods: All patients underwent VLNT at our institution between November 2014 and July 2020. Demographic data, volume measurements, bio-impedance scores, Quality of Life scores, and cellulitis episodes were recorded.
Results: A total of 89 patients with a mean follow-up time of 23.7Ī12 months were included. Donor sites consisted of the omentum (73%), axilla (13%), supraclavicular (7%), groin (3.5%), and others. 20% decrease (p=0.0239) in volume differential, and 27.5% decrease (p=0.0398) in L-DEX scores were recorded 2 years after VLNT. A significant improvement in Lymphedema Life Impact Scale (LLIS) scores manifested as 28.4% decrease (p=0.0398) was recorded 2 years after treatment. In addition, VLNT dramatically decreased the total number of cellulitis episodes by 93% (p=0.0008) 1 year after treatment as well as the average number of episodes per year (84.5% decrease, p=0.0002). No cases of donor site lymphedema were recorded (0%).
Conclusions: VLNT is a promising avenue in the treatment of lymphedema that provides quality of life-enhancing treatment to patients placed under a substantial burden of disease. This is the largest long-term prospective study to date to provide a broad view of VOLTís utility of use in lymphedema patients. With an exceptionally long-term follow-up, the results demonstrate a satisfactory reduction in limb volume, bioimpedance, and improved quality of life and emphasize the efficacy of VOLT as a reliable alternative to peripheral VLNT with no risk of donor site lymphedema and a particularly significant impact in reducing the incidence of cellulitis.
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