![]() In the setting of lower extremity lymphedema, this option may not always be indicated due to an increased risk of inducing morbidity in the unaffected extremity. The groin donor site is a popular and common source for VLN transfer. A variety of donor site options are paramount to decision-making because certain patients may or may not be candidates for flap harvest from specific donor sites. Increasing options for vascularized lymph node (VLN) donor sites have allowed surgeons to make individualized patient-specific decisions in every case. The submental artery should be retrogradely dissected from medial to lateral, and the capsule of the submandibular gland should be harvested with the flap. Most submental lymph nodes around the submandibular gland and facial vessels should be delicately harvested.Ī width of 5 cm of the medial platysma muscle should be preserved in order to avoid marginal mandibular nerve pseudoparalysis. One to three marginal mandibular nerves should be carefully preserved with a nerve stimulator under a microscope. The contraindications are local tumor recurrence and distant metastasis. The indications for submental vascularized lymph node flap transfer include Cheng’s Lymphedema Grades 2–4, total obstruction of the lymphatic system in Taiwan Lymphoscintigraphy Staging (TLS) T4–T6, partial obstruction of TLS P1–P3, without patent lymphatic vessels, repeated episodes of cellulitis, and failure to complete decongestive physical therapy. ![]() Preoperative Doppler ultrasound and magnetic resonance imaging are helpful for evaluating the number of sizable lymph nodes and the course of the facial artery. The upper margin of the flap is designed at the lower border of the mandible to result in an inconspicuous scar. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |