For patients with Cheng’s Lymphedema late Grade II to Grade IV lymphedema and no patent functioning lymphatics on indocyanine green (ICG) lymphography, a vascularized lymph node (VLN) flap transfer is recommended for treatment. Patients with Grade IV lymphedema may need liposuction or partial wedge excision, usually one year post VLN flap transfer.
The choice of VLN flap is based on patient preference for donor site and the availability of sizable lymph nodes assessed by preoperative ultrasonography. Given these factors, the vascularized submental lymph node (VSLN) flap is the most commonly preferred VLN flap by Dr. Cheng’s patients. The VSLN flap is transferred to a distal recipient site- dorsal wrist in the upper extremity or ankle in the lower extremity in accordance with the “pump” mechanism, catchment effect, and natural gravity effect to achieve maximal functional recovery. The unsightly skin on the dorsal wrist or ankle can be excised to form a linear scar one year after the VSLN flap transfer, with the lymphedematous limb becoming softer and smaller.
Dr. Cheng’s unique technique by transferring the vascularized lymph node flap to distal recipient site (dorsal wrist) has the best functional improvement regarding to the tissue becoming softer, arm smaller and lighter, less cellulitis, better cosmetic appearance, and most important not need to wear compression garment any more. This is really the improvement of quality of life.
The initial transferred flap in the dorsal wrist is not good looking, but the transferred skin may be removed for achieving better cosmesis at one-year postoperative under local anesthesia. The success rate of the vascularized lymph node flap is 98% in Cheng’s experience. With an average 18 months of follow up after VLNT surgery, 90% of BCRL patients had the improvement with an average circumferential difference improvement of 40%. Varied by individuals, the affected limb, in general, becomes much softer over time; and restriction of daily activities is minimized. Patients resume their normal life styles and retain confidence post operatively.
1. Tc-99m Lymphoscintigraphy Increased Clearance on Static Images
2. Vascularized Groin Lymph Node Transfer to Elbow of Post-op Lymphoscintigraphy
3. Vascularized Submental Lymph Node Transfer to wrist of Post-op Lymphoscintigraphy
4. Intra-op Image
Data source: Proposed pathway and mechanism of vascularized lymph node flaps. Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. Gynecol Oncol. 2016 Apr;141(1):182-8.
If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients.