Lymph node transfer
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Vascularised Lymph Node Transfer (VLNT) is a operation for the treatment of lymphoedema. It is most commonly used in the setting of secondary lymphoedema, where swelling of the arm or leg has occurred after treatment for cancer (commonly involving either surgery and/or radiotherapy).
VLNT aims to improve the swelling of the affected limb and reduce the need for compression garments. In that way it has similar aspirations to Lymphatico-Venular Anastomosis (LVA) surgery as detailed elsewhere in this website. However, for cases that are unsuitable for LVAs because of disease progression, VLNT may be suitable.
What does the treatment involve?
This operation involves taking lymph node containing tissue from one part of the body and transplanting it into the affected limb. Commonly used sites are from the groin, armpit (axilla), neck or abdomen. Tissue is taken with an intact blood supply and this is transferred and revascularised in the affected limb. After this, lymphatic tissue aims to collect lymphatic fluid in the limb and return to the circulation, as would be the normal situation. This operation requires general anaesthesia and requires between two and four days in hospital afterwards. Use of compression garments is essential after this surgery.
How should I prepare for the surgery?
Continued use of compression hosiery is important as part of treatment for lymphoedema and this is the case in the run-up to the surgery. There are no other specific things that patients need to do before this surgery.
How long is the recovery process?
This is surgery that takes a number of hours and typically requires an inpatient stay between two and four days. You are advised not to drive for a week or two after such an operation.
The recovery process after VLNT relates to the priorities of getting your wounds healed, ensuring the lymph node transfer remains vascularised and continuing with compression garment use. It takes some months for the positive benefit of the transfer to become apparent.
Specific risks and complications of this treatment
The risks of the surgery include the requirement of a scar in the donor site where the lymph node tissue is taken from. Additionally, a scar is required in the limb where the transfer is put. There is a small risk of the vascularised transfer not working, either in terms of blood supply to the tissue or in terms of eventual outcome of lymphoedema volume measurements. A recent randomised controlled trial, however, showed overall benefit in performing this surgery compared to not undergoing surgical intervention. Complications in the donor site region where tissue is taken from (in our hands, either the neck or the abdomen) are unusual and whilst a little numbness is common in the skin around this scar for a short time after surgery, significant motor weakness, bleeding or gastrointestinal upset are rare.
The major alternatives to this surgery are LVA surgery. If lymphatic function has already deteriorated to a point where microvascular reconstructive surgery is unlikely to give benefit, the principal alternatives include liposuction which dramatically corrects volume discrepancies but does require a specific approach to compression garment use.
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