FREE VASCULARISED LYMPH NODE TRANSFER
Free vascularised lymph node transfer (fVLNT) is a complex microsurgical procedure involving the transplant of a small group of lymph nodes from one
regional draining basin to the limb affected with lymphoedema.
In patients with stage 1 and 2 lymphoedema, 98% have a positive response to this procedure with about 50% having a significantly good outcome.
The mainstay of lymphedema treatment remains conservative physical therapy.
However, when this fails to failure of progression to resolution of the lymphoedema then a surgical technique is indicated.
Patient with clinically pitting lymphoedema would be suitable for this procedure.The presence of mostly lymphatic fluid and the predominant absence of fatty deposition can be confirmed by a Magnetic Resonance Scan (MRI).
A lymphoscintigraphy is also a useful technique to map the lymphatic drainage of the limb and also useful in the reverse mapping of the lymph nodes to be harvested from the donor site.
The procedure is performed under general anaesthesia and lasts for 4-6 hours.The inpatient stay is hospital is 4-5 days.
The site where the lymph nodes are to be placed is carefully prepared by meticulous dissect and removal of the scar tissue. Tiny recipient blood vessels are identified and meticulously dissected using microsurgical techniques. The small group of lymph nodes to be harvested is carefully mapped and harvested with tiny blood vessels (artery and vein). These are then microsurgically transplanted to the recipient site by anastomosing the tiny blood vessels.
Post-operatively, the patient is managed in a warm environment. After a week or so, the patient is fitted with a compression garment. Measurements are carefully done in a standardised manner and recorded for audit purposes at every visit post-operatively.