Free Muscle Flap Transfer as a Lymphatic Bridge for Upper Extremity Lymphedema

ABSTRACT

There are limited reports in the literature describing the use of muscle or skin pedicle flaps as a lymphatic bridge to treat obstructive lymphedema. This report demonstrates the successful use of a free muscle flap for a circumferential scar of a forearm as treatment for obstructive lymphedema. Lymphatic drainage is demonstrated across the free flap by lymphoscintigraphy postoperatively. This is the first case report using a free muscle flap to reestablish lymphatic flow across an area of obstructive limb lymphedema.

KEYWORDS

Free muscle flap - lymphatic bridge - obstructive lymphedema

REFERENCES

• 1 Gillies H, Fraser F R. Treatment of lymphoedema by plastic operation (a preliminary report).  Br Med J. 1935;  1 96-98
• 2 Smith J W, Conway H. Selection of appropriate surgical procedures in lymphedema.  Plast Reconstr Surg. 1962;  30 10-31
• 3 Gillies H. The lymphatic wick.  Proc R Soc Med. 1950;  43 1054-1056
• 4 Mowlem R. The treatment of lymphoedema.  Br J Plast Surg. 1948;  1 48-55
• 5 Gillies H, Millard D R. The Principles and Art of Plastic Surgery. Boston; Little, Brown and Company 1957
• 6 Medgyesi S. A successful operation for lymphoedema using a myocutaneous flap as a “wick”.  Br J Plast Surg. 1983;  36 64-66
• 7 Withey S, Pracy P, Wood S et al.. The use of a lymphatic bridge in the management of head and neck lymphoedema.  Br J Plast Surg. 2001;  54 716-719
• 8 Chitale V R. Role of tensor fascia lata musculocutaneous flap in lymphedema of the lower extremity and external genitalia.  Ann Plast Surg. 1989;  23 297-304
• 9 Smith A R, van Alphen W A, van der Pompe W B. Lymphatic drainage in patients after replantation of extremities.  Plast Reconstr Surg. 1987;  79 163-170
• 10 Slavin S A, Upton J, Kaplan W D et al.. An investigation of lymphatic function following free-tissue transfer.  Plast Reconstr Surg. 1997;  99 730-741
• 11 Khazanchi R K, Rakshit K, Bal C S et al.. Evaluation of lymphatic drainage and free flaps by lymphoscintigraphy a preliminary study.  Br J Plast Surg. 1996;  49 123-127
• 12 Anderson D K, Zarem H A. The lymphatics in experimental flaps.  Plast Reconstr Surg. 1977;  59 264-268
• 13 Anthony J P, Foster R D, Price D C et al.. Lymphatic regeneration following microvascular limb replantation: a qualitative and quantitative animal study.  J Reconstr Microsurg. 1997;  13 327-330
• 14 Wong L C. Regeneration of lymphatic vessels in the ear of the guinea pig.  J Pathology. 1980;  131 209-219
• 15 Slavin S A, Vanden Abbeele A D, Losken A et al.. Return of lymphatic function after free flap transfer for acute lymphedema.  Ann Surg. 1999;  229 421-427