Abstract
Background Vascularized lymph node transfer is an increasingly popular option for the treatment
of lymphedema. The omental donor site is advantageous for its copious soft tissue,
well-defined collateral circulation, and large number of available nodes, without
the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy
of the omental flap in the context of vascularized lymph node harvest.
Methods Consecutive abdominal computed tomography angiography (CTA) images performed at a
single institution over a 1-year period were reviewed. Right gastroepiploic artery
(RGEA) length, artery caliber, lymph node size, and lymph node location in relation
to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized
entropy criterion was used to calculate three-dimensional lymph node cluster locations
along the RGEA.
Results In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was
significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was
no significant gender difference in the number of lymph nodes identified. Average
lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males
vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each
with a distinct lymph node clustering pattern. Total lymph node number and size did
not differ among anatomical subgroups.
Conclusion The omentum is a reliable lymph node donor site with consistent anatomy. This study
serves as an aid in preoperative planning for vascularized lymph node transfer using
the omental flap.
Keywords
omental flap - vascularized lymph node transfer - lymphedema
