Vascularized lymph node transfer using axilla as recipient site restores lymphatic flow in upper limb lymphedema: Evidence from magnetic resonance lymphangiography

Background: Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment. Vascularized lymph node transfer(VLNT) is a promising approach to reduce lymphedema. This study used magnetic resonance lymphangiography(MRL) to assess lymphatic reconnections post-VLNT in patients with breast cancerrelated lymphedema(BCRL).Methods: The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4cases) or VLNT combined with breast reconstruction(2 cases) were retrospectively reviewed. All patients were examined using MRL preoperatively and at the 1-year follow-up. The morphological characteristics of the lymphatic network, dermal backflow patterns, and architecture of the lymph nodes were evaluated. Clinical outcomes, patient satisfaction, and complications were assessed.Results: At the 1-year follow-up, reduction in tissue edema and limb circumference was achieved in all six patients.In MRL, the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients. Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients. Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients. No disruption of the lymph flow in the donor area was detected.Conclusion: This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL. Overall, our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.