Recipient Site Choices and Donor Option Considerations for Vascularized Lymph Node Transfer

Lymphedema is a chronic debilitating condition that most commonly occurs after treatment for cancer in the industrialized world. The field of lymphedema surgery has revolutionized the care and treatment of lymphedema, but neither of the approaches, neither lymphaticovenous anastomosis nor a vascularized lymph node transfer, cures lymphedema. Despite the ongoing advancements, a number of issues remain unanswered regarding the most optimal lymph node donor site and the recipient location for the vascularized lymph node transfer. While a number of donor sites have been described, the decision on which one to use is based on a number of different factors. Aside from surgeon preference and experience and patient-related preferences along with body habitus and available donor sites, one must consider the anatomy and characteristics of each donor site when deciding which nodal basin to harvest and transfer. Equally important is the recipient location, where the selection of recipient sites is governed not only by the availability of the recipient vessels but also by which philosophy the operating surgeon endorses as the underlying mechanism of action of the transferred lymph nodes. This chapter aims to highlight the most commonly used donor sites for lymph node transfer, focusing on the characteristics of the flap that should be considered when deciding which flap to harvest based on the anticipated recipient site.