【摘要】

BACKGROUND:

Restoring the continuity of lymphatic drainage by lymphaticovenous or lymphaticolymphatic anastomosis was observed in the short term to be patent but eventually occluded because the elevated interstitial pressure will cause obliteration of these tiny, thin-walled, low-pressure lumens. The purpose of this study was to evaluate the outcome of vascularized groin lymph node transfer using the wrist as a recipientsite in patients with postmastectomy upper extremity lymphedema.

METHODS:

Between January of 1997 and June of 2005, 13 consecutive patients with a mean age of 50.69 +/- 11.25 years underwentvascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. A vascularized groin lymph node nourished by the superficial circumflex iliac vessels was harvested and transferred to the dorsal wrist of the lymphedematous limb. The superficial radial artery and the cephalic vein were used as the recipient vessels. Outcome was assessed by upper limb girth, incidence of cellulitis, and lymphoscintigraphy.

RESULTS:

All flaps survived, and one flap required reexploration, with successful salvage. No donor-site morbidity was encountered. At a mean follow-up of 56.31 +/- 27.12 months, the mean reduction rate (50.55 +/- 19.26 percent) of the lymphedematous limb was statistically significant between the preoperative and postoperative groups (p ＜ 0.01). The incidence of cellulitis was decreased in 11 patients. Postoperative lymphoscintigraphy indicated improved lymph drainage of the affected arm, revealing decreased lymph stasis and rapid lymphatic clearance. A hypothesis was proposed that the vascularized groin lymph node transfer might act as an internal pump and suction pathway for lymphatic clearance of lymphedematous limb.

CONCLUSIONS:

Vascularized groin lymph node transfer using the wrist as a recipient site is a novel and reliable procedure that significantly improves postmastectomy upper extremity lymphedema.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

The successful completion of the 5th World Symposium for Lymphedema Surgery (WSLS) marks another milestone in the development and advancement of the management of lymphedema. We present our experience in organizing such a scientific lymphedema conference as well as a summary of seven variable live surgeries used for treating lymphedema. An update of current knowledge and determination of future direction in the treatment of lymphedema was made possible via WSLS 2016.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

OBJECTIVE:

Vascularized groin lymph node flaps have been successfully transferred to the wrist to treat postmastecomy upper limblymphedema. This study investigated the anatomy, mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap transfer for the treatment of lower limb lymphedema.

METHODS:

Bilateral regional submental flaps were dissected from three fresh adult cadavers for histological study. A unilateral submental flapwas dissected in another six fresh cadavers after latex injection. The VSLN flap was transferred to the ankles of seven lower extremities in six patients with chronic lower extremity lymphedema. The mean patient age was 61 ± 9.4 years. The average duration of lymphedema symptoms was 71 ± 42.2 months.

RESULTS:

There was a mean of 3.3 ± 1.5 lymph nodes around the submental artery typically at the junction with the facial artery, on the six cadaveric histological sections. Mean of 2.3 ± 0.8 sizable lymph nodes were dissected and supplied by the submental artery in six cadaveric latex-injected submental flaps. All seven VSLN flaps survived. One flap required re-exploration for venous congestion but was successfully salvaged. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumference was 64 ± 11.5% above the knee, 63.7 ± 34.3% below the knee and 67.3 ± 19.2% above the ankle.

CONCLUSIONS:

The transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lowerextremity lymphedema.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

Vascularized groin lymph node flap transfer is an emerging approach to the treatment of postmastectomy upper limblymphedema. The authors describe the pertinent flap anatomy, surgical technique including different recipient sites, and outcome of this technique.

METHODS:

Ten cadaveric dissections were performed to clarify the vascular supply of the superficial groin lymph nodes. Ten patients underwentvascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema using the wrist (n=8) or elbow (n=2) as a recipient site. Ten patients who chose to undergo physical therapy were used as controls. Intraoperatively, indocyanine green was injected subcutaneously on the flap margin to observe the lymph drainage. Outcomes were assessed using improvement of circumferential differentiation, reduction rate, and decreased number of episodes of cellulitis.

RESULTS:

A mean 6.2±1.3 groin lymph nodes with consistent pedicles were identified in the cadaveric dissections. After indocyanine injection, the fluorescence was drained from the flap edge into the donor vein, followed by the recipient vein. At a mean follow-up of 39.1±15.7 months, the mean improvement of circumferential differentiation was 7.3±2.7 percent and the reduction rate was 40.4±16.1 percent in the vascularized groinlymph node group, which were statistically greater than those of the physical therapy group (1.7±4.6 percent and 8.3±34.7 percent, respectively; p＜0.01 and p=0.02, respectively).

CONCLUSIONS:

The superficial groin lymph nodes were confirmed as vascularized with reliable arterial perfusion. Vascularized groin lymph nodeflap transfer using the wrist or elbow as a recipient site is an efficacious approach to treating postmastectomy upper limb lymphedema.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

Vascularized groin lymph node transfer (VGLNT) has been successfully used to treat lymphedema. However, lack of familiarity with the inguinalnode anatomy and concerns regarding donor site morbidity have limited its widespread use. The purpose of this study was to use magneticresonance angiography (MRA) to clarify the inguinal anatomy and provide a reliable method for identifying the location of the superficial transverse inguinal lymph nodes. In this study MRA was used to evaluate the superficial inguinal lymph nodes in 117 patients. Coordinates of lymph nodes were plotted relative to an axis from the anterior superior iliac spine (ASIS) to the pubic tubercle (PT). The nodes were also plotted relative to the superficial circumflex iliac vein (SCIV) and superficial inferior epigastric vein (SIEV). A total of 1,938 lymph nodes were identified. These lymphnodes were concentrated on one-third the distance from the PT toward the ASIS and 3 cm perpendicularly below this line. About 67% of the superficial inguinal nodes were located within the bifurcation of the SIEV and SCIV. The results from this study provide useful guidelines for locating lymph nodes targeted for VGLNT.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

Vascularized lymph node flap transfer for the treatment of upper and lower limb lymphedema has had promising results. This study was performed to investigate the mechanism of lymph drainage of a vascularized lymph node flap both experimentally and clinically.

METHODS:

In the experimental study, 18 Sprague-Dawley rats were used to create 36 flaps, either a groin lymph node flap or an abdominal cutaneous flap that did not contain lymph nodes. Indocyanine green dye was injected into the edge of 12 lymph node flaps, directly into a lymph node of 12 lymph node flaps, and into the edge of 12 cutaneous flaps. In the clinical study, an identical study design was used, with 24 vascularized lymph node flaps and 12 cutaneous flaps not containing lymph nodes.

RESULTS:

Experimentally, fluorescence was detected in the pedicle vein after a mean latency period of 153 ± 129 seconds when the edge of the lymph node flap was injected and 12.8 ± 8.1 seconds when the lymph node was directly injected. Fluorescence was not detected in the pedicle vein of the cutaneous flaps (p ＜ 0.01). Clinically, fluorescence was detected in the pedicle vein after a mean latency period of 346 ± 249 seconds when the edge of the lymph node flap was injected and 23.5 ± 27.1 seconds when the lymph node was directly injected. Fluorescence was not detected in the pedicle vein of the cutaneous flaps (p ＜ 0.01).

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

Vascularized lymph node transfer is an effective surgical method in reducing lymphedema. This study provides the first detailed description of the surgical anatomy of the supraclavicular lymph node flap in regard to pedicle length, pedicle diameter, and the number of lymph nodes and their exact location inside the flap.

METHODS:

Bilateral supraclavicular dissections of nine fresh cadavers (five female) were performed. Before the dissection, the exact number of lymph nodes was determined sonographically by an experienced radiologist, and their distance from the jugular notch was measured. After anatomic dissection, the vascular pedicle's diameter and length were measured.

RESULTS:

The mean number of lymph nodes was 1.5 ± 1.85 on the right side and 3 ± 2.26 on the left. Their mean distance from the jugular notch was 8.29 ± 2.15 cm on the right and 6.10 ± 1.21 cm on the left. The pedicle's length was 4.72 ± 1.03 cm on the right and 4.86 ± 0.99 cm on the left, and its diameter 2.03 ± 0.83 on the right and 1.80 ± 0.77 on the left.

CONCLUSIONS:

The pedicle length and diameter of the supraclavicular lymph node flap are suitable for a microvascular tissue transfer

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

This study was aimed to establish a consistent lower limb lymphedema animal model for further investigation of the mechanism and treatment of lymphedema.

METHODS:

Lymphedema in the lower extremity was created by removing unilateral inguinal lymph nodes followed by 20, 30, and 40 Gy (groups IA, IB, and IC, respectively) radiation or by removing both inguinal lymph nodes and popliteal lymph nodes followed by 20 Gy (group II) radiationin Sprague-Dawley rats (350-400 g). Tc(99) lymphoscintigraphy was used to monitor lymphatic flow patterns. Volume differentiation was assessed by microcomputed tomography and defined as the percentage change of the lesioned limb compared to the healthy limb.

RESULTS:

At 4 weeks postoperatively, 0% in group IA (n = 3), 37.5% in group IB (n = 16), and 50% in group IC (n = 26) developed lymphedemain the lower limb with total mortality and morbidity rate of 0%, 56.3%, and 50%, respectively. As a result of the high morbidity and mortality rates, 20 Gy was selected, and the success rate for development of lymphedema in the lower limb in group II was 81.5% (n = 27). The mean volume differentiation of the lymphedematous limb compared to the health limb was 7.76% ± 1.94% in group II, which was statistically significant compared to group I (P ＜ 0.01).

CONCLUSIONS

Removal of both inguinal and popliteal lymph nodes followed by radiation of 20 Gy can successfully develop lymphedema in thelower limb with minimal morbidity in 4 months.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

A female patient with Klippel-Trenaunay syndrome, including hypertrophic bone and soft tissue in the forelimbs, bilateral lower limbslymphedema, port-wine stains, and superficial veins of Servelle, was presented. The diagnosis of lymphedema was confirmed by lymphoscintigraphy and indocyanine green lymphography. The novel treatments consisted of vascularized lymph node transplantation to the left lymphedematous extremity and lymphovenous anastomosis to the right lymphedematous extremity. Significant improvements in subjective and objective clinical outcome were observed early in the postoperative period with continued improvements during the follow-up period.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

As experience with vascularized lymph node (VLN) transfer has grown, new VLN sources have become apparent. Descriptive studies have elucidated variable lymph node presence in these donor basins. Yet, no study has evaluated preoperative imaging evaluation between donor sites in patients undergoing VLN transfer. This study was to compare the findings on duplex ultrasonography of the submental, groin, and supraclavicular lymph node basins in patients undergoing VLN transfer.

METHODS:

A review of a prospective database was performed for patients who had undergone preoperative planning for VLN transfer with duplex ultrasonography to provide objective donor-site characteristics. Multiple regression analysis was used to identify factors that correlated with specific flap characteristics. A P value less than 0.05 was considered statistically significant.

RESULTS:

Sixty-eight patients (28 upper extremities and 40 lower extremities) were identified as undergoing preoperative duplex ultrasonography for VLN transfer. Little variation was seen when evaluating donor sites for laterality in patients. Groin and submental VLN sites had 3.1 and 3.3 lymph nodes, respectively, compared with 0.9 lymph nodes in the supraclavicular donor site (p ＜ 0.01). Increasing age had an inverse relationship with estimated flap volume, whereas higher body mass index correlated with increasing flap thickness.

CONCLUSIONS

Preoperative imaging with duplex ultrasonography before VLN transfer may allow for accurate identification of specific VLN donor-site characteristics. When considering lymph node-specific characteristics, higher quantity of lymph nodes were found on the groin and submental flap axis compared with the transverse cervical artery axis.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

Nonanatomic (distal) placement of vascularized lymph node (VLN) transfers have shown efficacy in the treatment of extremity lymphedema, but the mechanism by which these flaps provide relief of lymphedema remains unclear. Intrinsic lymphovenous connections have been previously shown to exist in the transferred flap. But, the long-term interaction of the VLN flap and surrounding lymphedematous extremity has not been previously investigated.

METHODS:

A retrospective review of a prospective maintained database of patients who underwent VLN transfer was evaluated. Patients who underwent distal VLN transfer and had more than 1-year follow-up were identified. Lymphodynamic evaluation was performed using 0.3 to 0.6 mL indocyanine green (ICG) injection at 5 cm proximal to the flap edge on identified patients. Migration direction of dye and latency period was evaluated.

RESULTS:

In total, 20 patients were identified who met inclusion criteria. Average longterm follow-up was 27.3 months. The average circumference reduction of the affected extremity was 40.5%. ICG appearance within the VLN flap was found in all patients occurring on average in 178.3 seconds. In all cases, flow occurred in the distal direction (toward the flap) with proximal placement of dye. Latency period was found to inversely correlate with circumference reduction (p ＜ 0.01).

CONCLUSIONS

Distal, nonanatomic placement of VLN flaps provide sustained limb circumference reduction in extremity lymphedema patients following a minimum of 1-year postoperatively. Flap integration with the recipient site reliably occurs as witnessed with consistent ICG drainage, and occurs in the gravity-dependent direction. Faster clearance of ICG will result in improved clinical limb circumference reduction.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

Microsurgical techniques for the treatment of lymphedema rapidly increased in popularity. Although surgical success withvascularized lymph node (VLN) transfer has been demonstrated, limited studies have investigated the influence of microsurgical treatments on health-related quality-of-life (HRQoL) parameters. The aim of this study was to prospectively evaluate changes in HRQoL following VLN transferfor upper- and lower-extremity lymphedema using a validated instrument.

METHODS:

An Institutional Review Board-approved prospective study was performed of patients who underwent VLN transfer for symptomatic upper- or lower-limb lymphedema. A validated lymphedema-specific questionnaire-lymphoedema quality-of-life study-was utilized to assess specific quality-of-life parameters at multiple time points during the 12-month perioperative period. For a comparison with HRQoL metrics, limb circumference measurements were obtained to assess circumference differentiation.

RESULTS:

Twenty-five patients met the study criteria. Limb circumference analysis revealed significant early improvements following VLNtransfer, with continued improvement during the study period (upper-limb lymphedema: 24.4 %; lower-limb lymphedema: 35.2 %). These improvements were mirrored by improvements in all HRQoL domains and overall quality of life (p ＜ 0.01). The function, body appearance, symptom, and mood domains were all found to be significantly improved during the postoperative evaluation, with continued improvement being reported throughout the study period (p ＜ 0.01 within each domain).

CONCLUSIONS

Microsurgical treatment of lymphedema with VLN transfer procedures effectively decrease limb circumference. This improvement is mirrored by improvements in patient-reported outcomes and quality of life. These changes can be observed as soon as 1 month postoperatively, and continued steady improvement can be expected.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

PURPOSE:

This study was conducted to investigate the correlation between the number of vascularized lymph nodes (LN) transferred and resolution of hind limb lymphedema in a rat model.

METHODS:

Unilateral hind limb lymphedema was created in 18 male Sprague-Dawley rats following inguinal and popliteal LN resection and radiation. A para-aortic LN flap based on the celiac artery was subsequently transferred to the affected groin. The three study groups consisted of Group A (no LN transfer), Group B (transfer of a single vascularized LN), and Group C (transfer of three vascularized LNs). Volumetric analysis of bilateral hind limbs was performed using micro-CT imaging at 1, 2, and 3 months postoperatively. Lymphatic drainage was assessed with Tc(99) lymphoscintigraphy preoperatively and at 3 months postoperatively.

RESULTS:

A statistically significant volume reduction was seen in Groups B and C compared to Group A at all time points. Volume reduction of Group A vs.Group B at 1 month (8.6% ± 2.0% vs. 2.7% ± 2.6%, P ＜ 0.05), 2 months (9.3% ± 2.2% vs. -4.3% ± 2.7%, P ＜ 0.05), and 3 months (7.6% ± 3.3% vs. -8.9% ± 5.2%, P ＜ 0.05). Volume reduction of Group A vs. Group C at 1 month (8.6% ± 2.0% vs. -6.6% ± 3.1%, P ＜ 0.05), 2 months (9.3% ± 2.2% vs. -10.2% ± 4.6%, P ＜ 0.05), and 3 months (7.6% ± 3.3% vs. -9.1% ± 3.1%, P ＜ 0.05). Of note, comparison of Groups B and C demonstrated greater volume reduction in Group C at 1 (P ＜ 0.02) and 2 (P = 0.07) months postoperatively.

CONCLUSIONS

LN flap transfer is an effective procedure for the treatment of lymphedema. The number of vascularized LNs transferredcorrelates positively with the degree of volume reduction.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

PURPOSE:

This study was to investigate intraoperative assessment of side-to-end lymphovenous anastomosis (LVA) with indocyanine green(ICG) and the correlation between its patency and surgical outcome.

METHODS:

LVA was applied to five patients with early-stage lower extremity lymphedema. Side-to-end anastomosis and then end-to-endanastomosis were created as a second alternative. Immediately after the anastomosis, ICG was used to confirm its patency.

RESULTS:

The mean number of anastomoses was 2.0 ± 0.7, and the types of anastomoses were primarily side-to-end and secondarily end-to-end. The mean reduction rate was 63.8 ± 20.2% after LVA at 10 ± 6.4 months of follow-up. In all cases, the affected extremities became soft immediately after surgery, and no cellulitis episodes were observed.

CONCLUSIONS

Side-to-end LVA can be an effective treatment for early-stage lower extremity lymphedema. ICG lymphodynamic assessment is useful not only in the preoperative identification of functional lymphatics but also in the intraoperative visualization of new drainage routes in LVA surgery.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

OBJECTIVE:

To investigate the pump mechanism and pathway of lymph transit in vascularized lymph node flaps.

BACKGROUND:

Microsurgical treatment of lymphedema with vascularized lymph node transfer can improve signs and symptoms of disease, but the pathways and mechanisms of these flaps warrant further exploration.

METHODS:

(Animal model) 72 flaps were raised in 18 rats: 36 groin flaps contained lymph nodes (LN), 36 deep inferior epigastric artery perforatorflaps did not (non-LN). Indocyanine green (ICG) was added into normal saline (NS), 1%, 3%, 5%, 7% and 10% albumin. Three rats were assigned to each group. LN and non-LN flaps were submerged in solution and surveyed for venous fluorescence. In the 7% albumin and NS groups, volumetric change of solution was measured. (Human model) A similar experiment was performed in humans using five submental LN flaps.

RESULTS:

(Animal model) Fluorescence was detected in the venous pedicle of LN flaps submerged in 5%, 7% and 10% albumin, and half offlaps submerged in 3% albumin. Fluorescence was not detected in LN node flaps submerged in ICG-containing NS or 1% albumin solution. Fluorescence was not detected in non-LN flaps. There was greater volume reduction with LN flaps than non-LN flaps (p＜0.001). (Human model) Fluorescence was detected in the venous pedicle of all flaps immersed in lymph.

CONCLUSIONS

ICG fluorescence was detected in the venous pedicle of rat and human LN flaps submerged in lymph or albumin when the concentration was greater than 3%. Based on these results, a pathway for lymphatic uptake is presented.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

Evaluation of the lymphedema patients with appropriate staging is fundamental for further treatment. Treatment includes compressive decongestive therapy for stage 0 and 1 patients, lymphovenous anastomosis for stage 1 and 2 patients, vascularized lymph node transfer for stage 2 and above patients. Wedge resection, liposuction, and the Charles procedure are alternatives or additions to physiological procedures. The selection of donor lymph node flap and recipient site depends on the patient's lymphedema status and surgeon's expertise.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

We summarize the case of a 59-year-old woman with left lower limb lymphedema for 4 years post hysterectomy, pelvic lymph node dissection, radiation therapy, and chemotherapy for endometrial cancer. She underwent the Charles procedure on her left leg 2 years before being referred to our hospital and developed several cellulitis episodes and progressive lymphedema affecting her left toes and thigh. Bilateral vascularizedsubmental lymph node flaps were transferred to her left ankle and thigh, respectively. After a 5-month follow-up, the leg became softer and lighter without relapsing cellulites, and the circumferential reduction rates at 15 cm above knee, 15 cm below knee, and 10 cm above ankle were 23.3%, 50%, and 22.2%, respectively. The patient was satisfied with the functional recovery and discontinued use of compression garment postoperatively.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

OBJECTIVE:

Due to its consistent vascular and lymphatic anatomy, the vascularized submental lymph node flap is a reliable option for lymphedema treatment. Despite these advantages, flap harvest requires resection of platysma, which may cause a marginal mandibular nerve pseudo-paralysis. The aim of this study was to investigate the donor site morbidity of an innovative platysma-sparing vascularized submental lymph node flap transfer for treating extremity lymphedema.

METHODS:

Ten patients undergoing platysma sparing submental lymph-node flap harvest were prospectively enrolled in the study and compared with a control group of 10 patients who underwent standard submental lymph-node flap harvest. Photogrammetry analysis was used to assess donor site morbidity with regards to marginal mandibular nerve pseudo-paralysis.

RESULTS:

All flaps survived. No necrosis of the skin paddle was observed in both groups. There were no marginal mandibular nerve palsies in both group. There were no cases of marginal mandibular nerve pseudo-paralysis in the platysma sparing group.

CONCLUSIONS

The platysma sparing submental flap, while offering comparable functional improvement for extremity lymphedema, has the advantages of maximizing nerve and muscular preservation, significantly reducing donor site morbidity.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

INTRODUCTION:

The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, anatomic variability exists, making the harvest of this flap challenging. Knowledge and characterization of anatomic variability can aid the surgeon in safe and effective flap harvest.

METHODS:

A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed anatomic drawings of each case were reviewed to accurately account for anatomic variability and details.

RESULTS:

Forty-two patients were identified during the study period. Arteriovenous anatomic variability (A1-A2 and V1-V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course(P<0.01)

CONCLUSIONS

The VSLN flap can be safely and effectively harvested with knowledge of arteriovenous anatomic variability. Most commonly, the artery and vein travel together superior to the submandibular gland, but other variations exist, which may add time to surgical flap harvest and increased need for dissection.

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）

【摘要】

BACKGROUND:

arvesting the submental flap for vascularized lymph node transfer (VLNT) presents a challenging procedure because of, the topographic variation of the submental artery (SA) and the marginal mandible nerve (MMN) and the limited pedicle length for a free tissue transfer. The aim of this study was to evaluate surgical anatomical landmarks and variations of the submental lymph node flap (SLNF).

METHODS:

The authors examined the characteristics and landmarks of 18 SLNF in nine fresh cadavers. The diameter, length, and caliber of the SA and its relation to bony anatomic landmarks were measured. In addition, the number of lymph nodes (LNN) was evaluated through dissection and ultrasound.

RESULTS:

Within the designated SLNF (10 × 5 cm2 ), the number of LNN was on average 3 ± 0.6, with an average size of 4.5 ± 1.8 mm × 2.9 ± 1.2 mm. Projection of the LNN on the mandible, measured from the gnathion (GT, median-sagittal-plane) toward the gonion (GN, mandibular angle), was at 63.4 ± 5.8 mm (e.g., 65%) of the mandible for the first lymph node (LN), and for the following LNN was at 50.4 ± 7.7 mm (e.g., 52%), 44.0 ± 8.6 mm (e.g., 45%), and 40.50  ±  2.1 mm (e.g., 42%). The MMN consistently crossed the mandible body and the facial artery (FA) from dorso-caudal to ventro-cranial at 72 ± 5.2 mm, e.g., 75% of the mandible's length. Here, the nerve always lay superficial to the FA and was on average 0.96 ± 0.14 mm in diameter. Submental artery was located on average at 64 mm (e.g., 66%) of the mandible, with an average diameter of 1.34 ± 0.2 mm.

CONCLUSIONS

The submental lymph node flap has a constant vascular supply by the submental artery. Lymph node count is on average three. Lymph nodes are close to the submental artery and its perforators. Marginal mandibular nerve lies superficial to the facial artery and crosses the artery at 75% of the mandible body length (gnathion to gonion = 100%).

（全文可至http://www.ncbi.nlm.nih.gov/pubmed下載）