Compartimental harvesting of dual lymph node flap from the right supraclavicular area for the treatment of lower extremity lymphedema: A case series

Background: We report our clinical experience of a supraclavicular lymph node flap (LNF) using a novel method of harvesting based on the compartimental lymphatic and vascular anatomy of the right posterior neck triangle, which allows to harvest two independent LNFs from the same donor site. Patients and methods: We report a case series of 10 consecutive patients affected by cancer-related lower extremity lymphedema, who underwent compartimental dual LNF transfer from the right supraclavicular area to the affected lower limb, from August 2015 to March 2017. The superficial compartment flap (venous flap along the external jugular vein) was anastomosed in a flow-through fashion along the course of the great saphenous vein in the knee region, whereas the deep compartment flap (transverse cervical artery/vein flap) was anastomosed in an end-to-end fashion to the medial sural artery and comitantes vein. Flap viability was checked by color Doppler ultrasound postoperatively. Patients were assessed preoperatively and underwent follow-up at 6 and 12 months after surgery. Data were prospectively collected. Results: All the flaps resulted to be viable. No major postoperative complications were observed neither at the donor nor at the recipient sites. Patients did not report dysesthesia of the homoteral chest. An overall reduction in the lower extremity lymphedema (LEL) index (mean ± SD: 33.7 ± 22.5) and an improvement in the lymph flow and tracer appearance time at postoperative lymphoscintigraphy were observed. All the patients reported an improved quality of life after surgery. Conclusions: Compartimental supraclavicular dual LNF harvest seems promising in the treatment of peripheral lymphedema. Sparing of supraclavicular nerves might reduce the morbidity associated with the conventional surgical approach. Larger studies are needed to confirm our findings. Level of Evidence: IV, therapeutic study.