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Seth I, Bulloch G, Gibson D, Seth N, Hunter-Smith DJ, Rozen WM. Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chung JH, Hwang YJ, Park SH, Yoon ES. Preliminary outcomes of combined surgical approach for lower extremity lymphedema: supraclavicular lymph node transfer and lymphaticovenular anastomosis. J Plast Surg Hand Surg 2021; 56:261-269. [PMID: 34423730 DOI: 10.1080/2000656x.2021.1964980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vascularized lymph node transfer (VLNT) is a well-established surgical approach for treating lower extremity lymphedema (LEL). Since VLNT takes time to show effect, a combined approach with lymphaticovenular anastomosis (LVA) may be more advantageous to patients by inducing an immediate improvement. This study aims to describe our experience and evaluate the results of a combined approach. METHODS In this retrospective review, we analyzed a total of 12 patients that underwent simultaneous supraclavicular VLNT and LVA for the treatment of secondary LEL with the ISL stage II or III. Patients who had a follow-up period of less than 12 months were excluded. The supraclavicular flap, including superficial lymphoid tissue as well as deep cervical nodes, was harvested and anastomosed to the posterior tibial vessels. The pre- and postoperative change of circumference difference ratios and LEL index were compared. RESULTS All twelve flaps survived without re-exploration. An average of 2.3 LVAs were simultaneously performed. At 12.9 months of follow-up (range, 12-16 months), the postoperative mean circumference ratio was significantly improved than pre-operative in 10 cm above the knee (7.9 ± 7.2% vs 15.0 ± 7.6%, p = 0.01), 10 cm below the knee (8.5 ± 7.5% vs 17.4 ± 12.7%, p = 0.03) and lateral malleolus (16.5 ± 15.5% vs 28.6 ± 17.9%, p = 0.03). Also, the mean LEL index was decreased (preoperative 324.3 ± 53.0 vs postoperative 298.0 ± 44.6, p = 0.242) and eight patients showed improvement in LEL stage. CONCLUSIONS The combined approach showed a significant decrease in the circumference of LEL. Additional LVAs could reinforce the effect of a VLNT. Larger series with longer follow-up is needed to confirm our findings.
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Affiliation(s)
- Jae-Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University Hospital, Seoul, Republic of Korea
| | - Yong-Jae Hwang
- Department of Plastic and Reconstructive Surgery, Korea University Hospital, Seoul, Republic of Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Hospital, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Hospital, Seoul, Republic of Korea
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Gazyakan E, Bigdeli AK, Kneser U, Hirche C. Chimeric thoracodorsal lymph node flap with a perforator-based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report. Microsurgery 2020; 40:792-796. [PMID: 32259343 DOI: 10.1002/micr.30584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/18/2020] [Accepted: 03/20/2020] [Indexed: 11/11/2022]
Abstract
Free vascularized lymph node transfer (VLNT) is applied more and more in the treatment of lymphedema. A random-pattern skin island with VLNT is of use but can have its limitations in flap inset. We describe an option for free VLNT in the treatment of lower extremity lymphedema. We present the case of a chimeric thoracodorsal lymph node flap (TAP-VLNT) with a thoracodorsal artery perforator (TAP) flap (5 × 9 cm) to the lower leg in a 22-year old female patient with stage 2 lower leg lymphedema caused by severe traumatic skin decollement and postoperative scarring after a car accident. TAP flap enabled tailored and tension-free wound closure at the recipient site after scar release and lymph node flap inset. The anastomosis was performed to the anterior tibial artery. The postoperative course was uneventful with no complications or secondary donor-site lymphedema. Follow-up at 6 months showed reasonable cosmetic and functional outcomes. The circumference reduction rate was up to 11% and the patient reported improved quality of life. The purpose of this report is to describe a case of a more flexible lymph node flap inset and tension-free wound closure by harvesting a thin thoracodorsal artery perforator (TAP) skin island together with a thoracodorsal VLNT as a chimeric flap (TAP-VLNT) for treatment of lower extremity lymphedema. Larger series with longer follow-up data are needed to justify its widespread use and demonstrate long-term results.
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Affiliation(s)
- Emre Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery, University of Heidelberg, BG Clinic Ludwigshafen, Ludwigshafen, Germany
| | - Amir Khosrow Bigdeli
- Department of Hand, Plastic, and Reconstructive Surgery, University of Heidelberg, BG Clinic Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, University of Heidelberg, BG Clinic Ludwigshafen, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, University of Heidelberg, BG Clinic Ludwigshafen, Ludwigshafen, Germany
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Visconti G, Tartaglione G, Bartoletti R, Salgarello M. Compartimental harvesting of dual lymph node flap from the right supraclavicular area for the treatment of lower extremity lymphedema: A case series. J Plast Reconstr Aesthet Surg 2019; 72:211-215. [PMID: 30503371 DOI: 10.1016/j.bjps.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/28/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
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Liu HL, Chung JCK. The Lymph Node Content of Supraclavicular Lymph Node Flap: A Histological Study on Fresh Human Specimens. Lymphat Res Biol 2019; 17:537-542. [PMID: 30694716 DOI: 10.1089/lrb.2018.0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Vascularized lymph node transfer (VLNT) has become the established treatment for secondary lymphedema. The proposed mechanisms of VLNT include lymphangiogenesis and absorptive action of transplanted lymphatic tissue. Therefore, in theory, the lymph node content of lymph node flap is crucial to clinical response. The supraclavicular lymph node flap (SCLNF) has been described as one of the flap options for VLNT. However, its lymph node content has not been fully studied. The aim of this study is to find out the lymph node content of SCLNF with histological examination. Methods: Patients who required radical neck dissection or modified radical neck dissection due to cervical lymph node metastasis from head and neck cancer were included in this study. The SCLNF harvesting was performed as the first part of neck dissection. After flap harvesting, neck dissection was continued. The fresh SCLNF specimens were then sent for histological study. Results: Twelve SCLNFs were studied. The mean age of patients was 67.5 (range, 54-84) years. There were 10 males and 2 females. Seven flaps were harvested from the left side of neck, while five flaps were harvested from the right side of neck. The mean width, height, and thickness of SCLNF were 5.9 ± 0.6, 4.0 ± 0.5, and 1.8 ± 0.2 cm, respectively. The mean number of lymph nodes per flap was 8 ± 4.7 (range, 3-15). Conclusion: The lymph node content of SCLNF was confirmed. Its lymph node content is comparable to other lymph node flaps used in VLNT.
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Affiliation(s)
- Hin-Lun Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Joseph Chun-Kit Chung
- Department of Ear, Nose and Throat, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Anatomical Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomographic Angiography. Plast Reconstr Surg 2019; 142:1046-1052. [PMID: 30020230 DOI: 10.1097/prs.0000000000004772] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer. The anatomy of the gastroepiploic vessels, omentum, and lymph nodes has not been investigated. The purpose of this article is to describe the right gastroepiploic artery and related structures by using computed tomographic angiography. METHODS A retrospective analysis was conducted on 34 patients who underwent computed tomographic angiography. Statistical models were applied to identify right gastroepiploic artery and lymph node anatomical characteristics. RESULTS The right gastroepiploic artery was identified in 33 of 34 patients. It was found to have a diameter of 2.49 ± 0.66 mm at its origin. The gastroduodenal artery length before right gastroepiploic artery takeoff was 3.09 ± 1.31 cm. Twenty-five patients had lymph nodes in the right gastroepiploic artery lymphosome. There were 2.7 ± 2.12 lymph nodes identified per patient. The distance from the right gastroepiploic artery origin to the most proximal lymph node was 3.99 ± 2.21 cm. The distance from the gastroepiploic artery origin to the third lymph node was 9.12 ± 5.06 cm. Each lymph node was within 7.00 ± 6.2 mm of the right gastroepiploic artery. CONCLUSIONS When using the right gastroepiploic artery donor site for vascularized lymph node transfer, the plastic surgeon should anticipate using a pedicle length of 4 cm, a total flap length of 9 cm, and 3 cm of surrounding tissue to obtain at least three lymph nodes for transfer. Computed tomographic angiography is an effective imaging modality that can be used for patient-specific surgical navigation before vascularized lymph node transfer.
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Ho OA, Lin CY, Pappalardo M, Cheng MH. Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for Breast Cancer-Related Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1923. [PMID: 30656093 PMCID: PMC6326621 DOI: 10.1097/gox.0000000000001923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Abstract
Background: The vascularized groin and submental lymph node (VGLN and VSLN) flaps are valuable options in the treatment of lymphedema. This study was to compare outcomes between VGLN and VSLN transfers for breast cancer–related lymphedema. Methods: Between January 2008 and December 2016, VGLN and VSLN transfers for upper limb lymphedema were compared including flap characteristics, flap elevation time, complications, and limb circumference changes. Results: All flaps survived. Similar vein (2.6 versus 3.2 mm; P = 0.3) and artery diameter (2.1 versus 2.8 mm; P = 0.3) and number of lymph nodes (3 versus 4; P = 0.4) were found between VGLN and VSLN groups, respectively. Circumferential reduction rate was higher in VSLN than VGLN (P = 0.04) group. Vascular complication rate with salvage rate was not statistically different between the 2 groups. Donor-site complication and total complication rates were statistically higher in VGLN than VSLN flaps (7.7% versus 0%, P = 0.004; 46.2% versus 23.3%, P = 0.002). At a mean 39.8 ± 22.4 months, the circumferential reduction rate was statistically higher in VSLN than in the VGLN group (55.5 ± 14.3% versus 48.4 ± 23.9%, P = 0.04). Both flaps were effectively decreased in the episodes of cellulitis. Conclusions: Both VGLN and VSLN flaps are valuable surgical options in treating breast cancer–related lymphedema. However, the VSLN flap for breast cancer–related lymphedema is better in providing more significant improvements in limb circumference, a faster flap harvest time, decreased complication rates, and minimal donor-site iatrogenic lymphedema.
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Affiliation(s)
- Olivia A Ho
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Yu Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Marco Pappalardo
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Ochoa O, Metzner M, Theoharis C, Chrysopoulo M, Pisano S, Nastala C, Ledoux P, Arishita G, Garza R, Snider T. Deep inferior epigastric lymph node basin: Analysis of novel donor site for vascularized lymph node transfer among 10 consecutive patients. Microsurgery 2018; 39:215-220. [DOI: 10.1002/micr.30372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Oscar Ochoa
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | | | | | - Minas Chrysopoulo
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Steven Pisano
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Chet Nastala
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Peter Ledoux
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Gary Arishita
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Ramon Garza
- Plastic Reconstructive and Microsurgical Associates (PRMA) San Antonio Texas
| | - Ted Snider
- South Texas Pathology Associates San Antonio Texas
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Mesoappendix as potential donor site for vascularized lymph node transfer: anatomic study. J Surg Res 2018; 230:143-147. [PMID: 30100031 DOI: 10.1016/j.jss.2018.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/20/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The standard of care for treatment of lymphedema is manual lymphatic drainage and compression therapy, which is time intensive and requires a life-long commitment. Autologous lymph node transfer is a microsurgical treatment in which a vascularized lymph node flap is harvested with its blood supply and transferred to the lymphedematous region to assist with lymph fluid clearance. An ideal donor lymph node site minimizes the risk of iatrogenic lymphedema and other donor site morbidity. To address this, we have used jejunal mesentery lymph nodes and omental flaps and hypothesize that the mesoappendix, as a "spare part," may be an ideal autologous lymph node transfer donor site. METHODS In this Institutional Review Board-approved study, 25 mesoappendix pathology specimens resected for benign disease underwent gross pathologic examination for the presence of lymph nodes and measurement of the appendicular artery and vein caliber and length. RESULTS A single lymph node was present in two of 25 specimens (8%). Mean arterial and vein calibers at the point of ligation were 0.87 ± 0.44 mm and 0.86 ± 0.48 mm (range 0.30-2.2 mm and 0.25-2.2 mm), respectively. Mean arterial and vein length was 1.70 ± 1.06 cm and 1.84 ± 1.09 cm (range 0.8-4.5 cm for each), respectively. CONCLUSIONS The mesoappendix rarely contains a lymph node. The artery and vein calibers of 46% of the specimens were greater than 0.8 mm, the minimum caliber preferred for microsurgical anastomosis. If transplantation of a vascularized lymph node for the treatment of lymphedema is desired, the mesoappendix is inconsistent in providing adequate lymph nodes.
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Tinhofer IE, Meng S, Steinbacher J, Roka-Palkovits J, Györi E, Reissig LF, Cheng MH, Weninger WJ, Tzou CH. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study. J Surg Oncol 2017; 116:1062-1068. [PMID: 28782246 DOI: 10.1002/jso.24783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/03/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND One promising surgical treatment of lymphedema is the VLNT. Lymph nodes can be harvested from different locations; inguinal, axillary, and supraclavicular ones are used most often. The aim of our study was to assess the surgical anatomy of the lateral thoracic artery lymph node flap. MATERIALS AND METHODS In total, 16 lymph node flaps from nine cadavers were dissected. Flap markings were made between the anterior and posterior axillary line in dimensions of 10 × 5 cm. Axillary lymph nodes were analyzed using high-resolution ultrasound and morphologically via dissection. The cutaneous vascular territory of the lateral thoracic artery was highlighted via dye injections, the pedicle recorded by length, and diameter and its location in a specific coordinate system. RESULTS On average, 3.10 ± 1.6 lymph nodes were counted per flap via ultrasound. Macroscopic inspection showed on average 13.40 ± 3.13. Their mean dimensions were 3.76 ± 1.19 mm in width and 7.12 ± 0.98 mm in length by ultrasonography, and 3.83 ± 2.14 mm and 6.30 ± 4.43 mm via dissection. The external diameter of the lateral thoracic artery averaged 2.2 ± 0.40 mm with a mean pedicle length of 3.6 ± 0.82 cm. 87.5% of the specimens had a skin paddle. CONCLUSIONS The lateral thoracic artery-based lymph node flap proved to be a suitable alternative to other VLNT donor sites.
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Affiliation(s)
- Ines E Tinhofer
- Department of Anatomy, Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria
| | - Stefan Meng
- Department of Anatomy, Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria.,Department of Radiology, Hospital Kaiser-Franz-Josef, Vienna Hospital Association, Vienna, Austria
| | - Johannes Steinbacher
- Department of Anatomy, Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria
| | - Julia Roka-Palkovits
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Eva Györi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas F Reissig
- Department of Anatomy, Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria
| | - Ming-Huei Cheng
- Division of Plastic Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial University Hospital Taipei, Taipei, Taiwan
| | - Wolfgang J Weninger
- Department of Anatomy, Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria
| | - Chieh Han Tzou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Inbal A, Teven CM, Chang DW. Latissimus dorsi flap with vascularized lymph node transfer for lymphedema treatment: Technique, outcomes, indications and review of literature. J Surg Oncol 2016; 115:72-77. [PMID: 27943281 DOI: 10.1002/jso.24347] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES One of the surgical treatment options for lymphedema is vascularized lymph node transfer (VLNT). We present our experience with latissimus dorsi (LD) flap based VLNT for lymphedema treatment. METHODS We reviewed 14 consecutive patients treated with pedicled or free LD VLNT between 2014 and 2016 for recalcitrant upper or lower extremity lymphedema. Seven patients underwent lymphovenous bypass in addition to LD VLNT. Limb volume and quality of life scores using the Lymphedema Life Impact Scale (LLIS) were analyzed for quantitative and qualitative assessment. RESULTS Mean duration of lymphedema was 69 months (range 24-124 months). Follow-up ranged from 3 to 12 months (mean 6.7 month). Major complications included one free flap loss and one reoperation for thrombosis. Mean preoperative volume differential between normal and affected limb was 35% (range 3-87%). Volume differential reduction was 48%, 28%, and 46% at 3, 6, and 12 months, respectively. The LLIS score improved from mean of 46.8 before surgery to a mean of 38.6 at 12 month, demonstrating improvement in quality of life. CONCLUSIONS The LD VLNT provides a viable option for treatment of UE and LE lymphedema in selected patients. J. Surg. Oncol. 2017;115:72-77. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amir Inbal
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Chad M Teven
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - David W Chang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
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Steinbacher J, Tinhofer IE, Meng S, Reissig LF, Placheta E, Roka-Palkovits J, Rath T, Cheng MH, Weninger WJ, Tzou CH. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer. J Surg Oncol 2016; 115:60-62. [DOI: 10.1002/jso.24346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Johannes Steinbacher
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Ines E. Tinhofer
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Stefan Meng
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
- Department of Radiology; Kaiser-Franz-Josef-Hospital; Vienna Austria
| | - Lukas F. Reissig
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Eva Placheta
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Julia Roka-Palkovits
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Thomas Rath
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Center for Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Wolfgang J. Weninger
- Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Chieh Han Tzou
- Division of Plastic and Reconstructive Surgery, Department of Surgery; Medical University of Vienna; Vienna Austria
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Tzou CH, Meng S, Ines T, Reissig L, Pichler U, Steinbacher J, Pona I, Roka-Palkovits J, Rath T, Weninger WJ, Cheng MH. Surgical anatomy of the vascularized submental lymph node flap: Anatomic study of correlation of submental artery perforators and quantity of submental lymph node. J Surg Oncol 2016; 115:54-59. [DOI: 10.1002/jso.24336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Chieh Han Tzou
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Stefan Meng
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Tinhofer Ines
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Lukas Reissig
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Ursula Pichler
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Johannes Steinbacher
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Igor Pona
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Julia Roka-Palkovits
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Thomas Rath
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Wolfgang J. Weninger
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery; Center for Tissue Engineering; Chang Gung Memorial Hospital; College of Medicine; Chang Gung University; Taoyuan Taiwan
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