Delayed primary retention suture for inset of vascularized submental lymph node flap for lower extremity lymphedema

J Surg Oncol. 2020 Jan;121(1):138-143. doi: 10.1002/jso.25520. Epub 2019 Jul 5.

Abstract

Background: Vascularized lymph node transfer (VLNT) has become one of the effective surgical treatments for extremity lymphedema. This study was to evaluate the re-exploration and total complication rates of VLNT for lower extremity lymphedema between two different flap inset techniques.

Methods: Sixty-nine patients who underwent 74 submental VLNT transfers between 2008 and 2018 were retrospectively studied. Fifty-six flaps were inset using a new delayed primary retention suture (DPRS) technique and other 18 flaps using conventional interrupted sutures as the non-DPRS group.

Results: The overall flap success rate was 100%. The DPRS group was released at a mean of 1.7 ± 0.7 times and took a mean of 10.3 ± 3.3 days for wound closure. There were no statistical differences in demographics, mean symptom duration, and mean Cheng's Lymphedema Grading between two groups. Mean frequency of cellulitis of 2.5 ± 1.5 times/year in non-DPRS group was significantly greater than 1.4 ± 1.6 times/year in DPRS group (P = .01). The re-exploration and total complication rates were 5.4% and 7.1% in DPRS group, and 27.8% and 33.3% in non-DPRS group, respectively (P = .02 and .02, respectively).

Conclusions: The DPRS technique is a safe, simple, and reliable method for insetting the submental VLNT, which statistically decreased the re-exploration and total complication rates.

Keywords: lymphedema; microsurgery; re-exploration; submental flap; vascularized lymph node transfer; venous complication.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Extremities / surgery
  • Female
  • Humans
  • Lymph Nodes / blood supply*
  • Lymph Nodes / transplantation*
  • Lymphedema / surgery*
  • Middle Aged
  • Retrospective Studies
  • Surgical Flaps / surgery*
  • Suture Techniques
  • Sutures*
  • Treatment Outcome