Lower extremity lymphedema and vascularized lymph node transfer recipient sites: a review of the current literature

Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow. Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes. This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific, disease-specific and surgery-specific factors in considering recipient sites from the proximal, middle, and distal lower extremity. The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented. An omental flap to the middle lower extremity (mid-thigh, popliteal fossa, or medial calf) is then recommended due to the abundance of lymphatic tissue, proximity to pooled lymph fluid, and avoidance of added bulk or poor cosmesis of the distal lower extremity. However, additional clinical outcomes studies are needed and represent an area of further investigation.