Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema

Lymphedema is characterized by the accumulation of lymph fluid within the subcutaneous tissues resulting in a state of chronic inflammation that over time leads to fibrosis and further disruption of lymphatic drainage.1 Recent studies have shown that select patients with lymphedema may benefit from vascularized lymph node transfer (VLNT) procedures.2 These reports have largely focused onpatientswith extremity lymphedema, particularly in situations where normal lymphatic drainagehas been interrupted by previous lymphadenectomy and radiotherapy. One theory for how this occurs is that the transferred lymph nodes produce vascular endothelial growth factor (VEGF), a signaling protein that stimulates lymphangiogenesis in the recipient site.3 Another prominent theory emphasizes that an inherent pumpmechanismwithin transferred lymph nodes facilitates the absorption of surrounding interstitial fluid and returns this fluid back to the venous circulation.4,5 Although the exact mechanism is still under investigation; it is clear that some patients certainly benefit from VLNT and exhibit measurable reductions of limb volume and circumference.