Key topic: Vascularized lymph node transplant and recipient site selection

Vascularized lymph node transplant (VLNT) is an effective treatment for lymphedema, and several VLN flaps have been described. The decision regarding anatomic (orthotopic) versus non-anatomic (heterotopic) recipient site selection includes appraisal of the distribution of the lymphedema on clinical and on physiological imaging. Within these locations, the specific decisions regarding recipient sites are made with regard to the recipient site relative qualities and recipient blood vessels. The choice of VLNT is individualized to the patient, taking account of the results of imaging, clinical `examination findings, body habitus, and availability and quality of flap donor sites, as well as patient and surgeon preferences. Where the entire extremity is affected, dual-level transfer (simultaneous orthotopic proximal, and heterotopic distal, transfer) may improve clinical outcomes by enhancing the lymphatic drainage throughout the affected limb. In this chapter, we present an algorithmic approach to recipient site and VLNT selection with respect to these.