Advances in intra-abdominal vascularized lymph node transfer for treatment of limb lymphedema_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Yuezhong ,  DENG Chengliang

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

DENG Chengliang, Email: cheliadeng@sina.com

Keywords：

Lymphedema; vascularized lymph node transfer; omentum; mesentery

DOI：

10.7507/1002-1892.202509066

Video：

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Objective To summarize recent clinical advances in intra-abdominal vascularized lymph node transfer (VLNT) for treatment of limb lymphedema. Methods A comprehensive review of the literature on intra-abdominal VLNT was conducted, outlining its historical development, relevant anatomy, and clinical applications, with emphasis on clinical outcomes. Results Intra-abdominal donor sites, such as the omentum and mesentery, are rich in lymphoid tissue and exhibit favorable anti-infective properties. Intra-abdominal VLNT has been widely applied in clinical practice internationally, while reports from China remain limited. Clinical studies indicate that the intra-abdominal VLNT can effectively reduce limb swelling, lower incidence of infection, and improve quality of life in patients with limb lymphedema. It can also be combined with lymphaticovenular anastomosis, reductive procedures, and breast reconstruction to further alleviate symptoms and enhance patient-reported outcomes. Conclusion Intra-abdominal VLNT holds clinical application potential for the treatment of limb lymphedema, but more rigorous, standardized clinical studies are needed to further verify its feasibility and efficacy.

Citation： CHEN Yuezhong, DENG Chengliang. Advances in intra-abdominal vascularized lymph node transfer for treatment of limb lymphedema. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(1): 108-115. doi: 10.7507/1002-1892.202509066 Copy

1.	Chen J, Wang Y, Tu S, et al. A novel lymphosome-based long-lasting rat tail model of lymphedema. J Reconstr Microsurg, 2025. doi: 10.1055/a-2687-0506.
2.	Chen J, Wang L, Wu X, et al. Case Report: Surgical management of primary lymphedema with a novel PROX1 mutation involving upper and lower limbs. Front Genet, 2025, 16: 1560471. doi: 10.3389/fgene.2025.1560471.
3.	Schaverien MV, Coroneos CJ. Surgical treatment of lymphedema. Plast Reconstr Surg, 2019, 144(3): 738-758.
4.	Brown S, Campbell AC, Kuonqui K, et al. The future of lymphedema: potential therapeutic targets for treatment. Curr Breast Cancer Rep, 2023. doi: 10.1007/s12609-023-00491-5.
5.	Chen J, Chen Y, Wang L, et al. Identification of novel hub genes and pathways predictive of fibrosis progression in cancer-related lymphedema through integrated multi-omics. Front Immunol, 2025, 16: 1625972. doi: 10.3389/fimmu.2025.1625972.
6.	邓呈亮, 陈君哲, 肖顺娥, 等. 基于算法浅谈继发性下肢淋巴水肿的外科整合治疗. 中华烧伤与创面修复杂志, 2025, 41(6): 516-524.
7.	Mondry TE, Riffenburgh RH, Johnstone PA. Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J, 2004, 10(1): 42-38.
8.	陈宗灿, 陈君哲, 王媛媛, 等. 基于旋髂浅动脉穿支的血管化淋巴结移植联合淋巴管静脉吻合术及脂肪抽吸术一期治疗乳腺癌术后上肢淋巴水肿. 中国修复重建外科杂志, 2025, 39(9): 1114-1121.
9.	Goldsmith HS, de Los Santos R. Omental transposition for the treatment of chronic lymphedema. Rev Surg, 1966, 23(4): 303-304.
10.	Goldsmith HS. Long term evaluation of omental transposition for chronic lymphedema. Ann Surg, 1974, 180(6): 847-849.
11.	Egorov YS, Abalmasov KG, Ivanov VV, et al. Autotransplantation of the greater omentum in the treatment of chronic lymphedema. Lymphology, 1994, 27(3): 137-143.
12.	Nguyen AT, Suami H. Laparoscopic free omental lymphatic flap for the treatment of lymphedema. Plast Reconstr Surg, 2015, 136(1): 114-118.
13.	Frey JD, Yu JW, Cohen SM, et al. Robotically assisted omentum flap harvest: a novel, minimally invasive approach for vascularized lymph node transfer. Plast Reconstr Surg Glob Open, 2020, 8(4): e2505. doi: 10.1097/GOX.0000000000002505.
14.	Ciudad P, Manrique OJ, Date S, et al. Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report. Microsurgery, 2018, 38(5): 553-557.
15.	Ciudad P, Manrique OJ, Agko M, et al. Ileocecal vascularized lymph node transfer for the treatment of extremity lymphedema: A case report. Microsurger, 2019, 39(1): 81-84.
16.	Coriddi M, Wee C, Meyerson J, et al. Vascularized jejunal mesenteric lymph node transfer: a novel surgical treatment for extremity lymphedema. J Am Coll Surg, 2017, 225(5): 650-657.
17.	Wang AW, Prieto JM, Cauvi DM, et al. The greater omentum-a vibrant and enigmatic immunologic organ involved in injury and infection resolution. Shock, 2020, 53(4): 384-390.
18.	程舸畅, 唐举玉. 游离血管化网膜淋巴结移植治疗四肢淋巴水肿的进展. 组织工程与重建外科, 2023, 19(1): 88-90, 100. doi: 10.3969/j.issn.1673-0364.2023.01.018.
19.	Yoo H, Hong KY, Min S, et al. Distribution of perigastric station 4d lymph nodes in vascularized gastroepiploic lymph node transfer: an anatomic study and case series. Ann Surg Oncol, 2024, 31(6): 3694-3704.
20.	Okabe Y. Development and organization of omental milky spots. Immunol Rev, 2024, 324(1): 68-77.
21.	Shimotsuma M, Shields JW, Simpson-Morgan MW, et al. Morpho-physiological function and role of omental milky spots as omentum-associated lymphoid tissue (OALT) in the peritoneal cavity. Lymphology, 1993, 26(2): 90-101.
22.	Nguyen AT, Suami H, Hanasono MM, et al. Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. J Surg Oncol, 2017, 115(1): 84-89.
23.	Coriddi M, Skoracki R, Eiferman D. Vascularized jejunal mesenteric lymph node transfer for treatment of extremity lymphedema. Microsurgery, 2017, 37(2): 177-178.
24.	Daniel BW, Sonnenberg AM, Stern JE, et al. Intra-abdominal lymph node flaps in lymphedema therapy: An anatomical guide to donor site selection. J Surg Oncol, 2022, 125(2): 134-144.
25.	Ruter D, Chen W, Garza R 3rd, et al. Mesoappendix as potential donor site for vascularized lymph node transfer: anatomic study. J Surg Res, 2018, 230: 143-147.
26.	Grünherz L, Barbon C, von Reibnitz D, et al. Analysis of different outcome parameters and quality of life after different techniques of free vascularized lymph node transfer. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101934. doi: 10.1016/j.jvsv.2024.101934.
27.	Maruccia M, Giudice G, Ciudad P, et al. Lymph node transfer and neolymphangiogenesis: from theory to evidence. Plast Reconstr Surg, 2023, 152(5): 904e-912e.
28.	Shrout MA, Plonkowski AT, Morris BE, et al. Radiographic enhancement of lymph nodes 9 months after omental lymph node transfer. Plast Reconstr Surg Glob Open, 2024, 12(11): e6305. doi: 10.1097/GOX.0000000000006305.
29.	Elia R, Chen HC, Cazzato G, et al. Evaluation of modulation of immunity by lymph node transfer: A preliminary histological evidence in lymphedema patients. Microsurgery, 2024, 44(1): e31123. doi: 10.1002/micr.31123.
30.	Ciudad P, Kiranantawat K, Sapountzis S, et al. Right gastroepiploic lymph node flap. Microsurgery, 2015, 35(6): 496-497.
31.	Ciudad P, Huayllani MT, Forte AJ, et al. Vascularized lymph node transfer for the treatment of posttraumatic lower extremity lymphedema: a preliminary report. Indian J Plast Surg, 2022, 55(1): 97-101.
32.	Ciudad P, Agko M, Perez Coca JJ, et al. Comparison of long-term clinical outcomes among different vascularized lymph node transfers: 6-year experience of a single center’s approach to the treatment of lymphedema. J Surg Oncol, 2017, 116(6): 671-682.
33.	Ciudad P, Manrique OJ, Date S, et al. A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience. J Surg Oncol, 2017, 115(1): 37-42.
34.	Brown S, Mehrara BJ, Coriddi M, et al. A prospective study on the safety and efficacy of vascularized lymph node transplant. Ann Surg, 2022, 276(4): 635-653.
35.	Ciudad P, Manrique OJ, Date S, et al. Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. Microsurgery, 2017, 37(7): 771-779.
36.	Elia R, Chen HC, Taranto GD, et al. Gastroepiploic vascularized lymph node transfer for extremities’ lymphedema: Is two better than one? A retrospective case-control study. J Plast Reconstr Aesthet Surg, 2022, 75(9): 3129-3137.
37.	Li Y, Dong R, Li Z, et al. Intra-abdominal vascularized lymph node transfer for treatment of lymphedema: A systematic literature review and meta-analysis. Microsurgery, 2021, 41(8): 802-815.
38.	Kumagai Y, Ishiguro T, Haga N, et al. Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence. World J Surg, 2014, 38(1): 138-143.
39.	Dayan JH, Voineskos S, Verma R, et al. Managing venous hypertension in vascularized omentum lymphatic transplant: restoring bidirectional venous drainage. Plast Reconstr Surg, 2018, 141(2): 326e-327e.
40.	Johnson AR, Bravo MG, Granoff MD, et al. Flow-through omental flap for vascularized lymph node transfer: a novel surgical approach for delayed lymphatic reconstruction. Plast Reconstr Surg Glob Open, 2019, 7(9): e2436. doi: 10.1097/GOX.0000000000002436.
41.	Lee BS, Granoff MD, Pardo J, et al. Flowthrough omental flap for vascularized lymph node transplant of the lower extremity. Plast Reconstr Surg, 2022, 149(3): 542e-546e.
42.	Schaverien MV, Hofstetter WL, Hall MS, et al. Jejunal mesenteric vascularized lymph node transplantation for lymphedema: outcomes and technical modifications. Plast Reconstr Surg, 2022, 149(4): 700e-710e.
43.	Kraft CT, Eiferman D, Jordan S, et al. Complications after vascularized jejunal mesenteric lymph node transfer: A 3-year experience. Microsurgery, 2019, 39(6): 497-501.
44.	Lo Torto F, Kaciulyte J, Di Meglio F, et al. Orthotopic vascularized lymph node transfer in breast cancer-related lymphedema treatment: Functional and life quality outcomes. Microsurgery, 2024, 44(2): e31147. doi: 10.1002/micr.31147.
45.	Manrique OJ, Bustos SS, Kapoor T, et al. Gastroepiploic vascularized lymph node transfer for the treatment of extremity lymphedema: comparison between middle and distal inset. Gland Surg, 2020, 9(2): 528-538.
46.	Ciudad P, Manrique OJ, Date S, et al. Simultaneous vascularized lymph node transfer and carpal tunnel release for treatment of advanced stage of breast cancer-related lymphedema with carpal tunnel syndrome. Microsurgery, 2017, 37(6): 745-746.
47.	Fuse Y, Fanning JE, Boyd T, et al. The Kager triangle: An anatomic review and potential implications for lymphatic surgery. Plast Reconstr Surg Glob Open, 2025, 13(5): e6791. doi: 10.1097/GOX.0000000000006791.
48.	邓呈亮, 陈君哲, 章一新. 继发性肢体淋巴水肿的外科整合治疗. 中华损伤与修复杂志(电子版), 2024, 19(3): 185-191.
49.	Di Taranto G, Bolletta A, Chen SH, et al. A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy. Microsurgery, 2021, 41(1): 34-43.
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1. Chen J, Wang Y, Tu S, et al. A novel lymphosome-based long-lasting rat tail model of lymphedema. J Reconstr Microsurg, 2025. doi: 10.1055/a-2687-0506.
2. Chen J, Wang L, Wu X, et al. Case Report: Surgical management of primary lymphedema with a novel PROX1 mutation involving upper and lower limbs. Front Genet, 2025, 16: 1560471. doi: 10.3389/fgene.2025.1560471.
3. Schaverien MV, Coroneos CJ. Surgical treatment of lymphedema. Plast Reconstr Surg, 2019, 144(3): 738-758.
4. Brown S, Campbell AC, Kuonqui K, et al. The future of lymphedema: potential therapeutic targets for treatment. Curr Breast Cancer Rep, 2023. doi: 10.1007/s12609-023-00491-5.
5. Chen J, Chen Y, Wang L, et al. Identification of novel hub genes and pathways predictive of fibrosis progression in cancer-related lymphedema through integrated multi-omics. Front Immunol, 2025, 16: 1625972. doi: 10.3389/fimmu.2025.1625972.
6. 邓呈亮, 陈君哲, 肖顺娥, 等. 基于算法浅谈继发性下肢淋巴水肿的外科整合治疗. 中华烧伤与创面修复杂志, 2025, 41(6): 516-524.
7. Mondry TE, Riffenburgh RH, Johnstone PA. Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J, 2004, 10(1): 42-38.
8. 陈宗灿, 陈君哲, 王媛媛, 等. 基于旋髂浅动脉穿支的血管化淋巴结移植联合淋巴管静脉吻合术及脂肪抽吸术一期治疗乳腺癌术后上肢淋巴水肿. 中国修复重建外科杂志, 2025, 39(9): 1114-1121.
9. Goldsmith HS, de Los Santos R. Omental transposition for the treatment of chronic lymphedema. Rev Surg, 1966, 23(4): 303-304.
10. Goldsmith HS. Long term evaluation of omental transposition for chronic lymphedema. Ann Surg, 1974, 180(6): 847-849.
11. Egorov YS, Abalmasov KG, Ivanov VV, et al. Autotransplantation of the greater omentum in the treatment of chronic lymphedema. Lymphology, 1994, 27(3): 137-143.
12. Nguyen AT, Suami H. Laparoscopic free omental lymphatic flap for the treatment of lymphedema. Plast Reconstr Surg, 2015, 136(1): 114-118.
13. Frey JD, Yu JW, Cohen SM, et al. Robotically assisted omentum flap harvest: a novel, minimally invasive approach for vascularized lymph node transfer. Plast Reconstr Surg Glob Open, 2020, 8(4): e2505. doi: 10.1097/GOX.0000000000002505.
14. Ciudad P, Manrique OJ, Date S, et al. Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report. Microsurgery, 2018, 38(5): 553-557.
15. Ciudad P, Manrique OJ, Agko M, et al. Ileocecal vascularized lymph node transfer for the treatment of extremity lymphedema: A case report. Microsurger, 2019, 39(1): 81-84.
16. Coriddi M, Wee C, Meyerson J, et al. Vascularized jejunal mesenteric lymph node transfer: a novel surgical treatment for extremity lymphedema. J Am Coll Surg, 2017, 225(5): 650-657.
17. Wang AW, Prieto JM, Cauvi DM, et al. The greater omentum-a vibrant and enigmatic immunologic organ involved in injury and infection resolution. Shock, 2020, 53(4): 384-390.
18. 程舸畅, 唐举玉. 游离血管化网膜淋巴结移植治疗四肢淋巴水肿的进展. 组织工程与重建外科, 2023, 19(1): 88-90, 100. doi: 10.3969/j.issn.1673-0364.2023.01.018.
19. Yoo H, Hong KY, Min S, et al. Distribution of perigastric station 4d lymph nodes in vascularized gastroepiploic lymph node transfer: an anatomic study and case series. Ann Surg Oncol, 2024, 31(6): 3694-3704.
20. Okabe Y. Development and organization of omental milky spots. Immunol Rev, 2024, 324(1): 68-77.
21. Shimotsuma M, Shields JW, Simpson-Morgan MW, et al. Morpho-physiological function and role of omental milky spots as omentum-associated lymphoid tissue (OALT) in the peritoneal cavity. Lymphology, 1993, 26(2): 90-101.
22. Nguyen AT, Suami H, Hanasono MM, et al. Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. J Surg Oncol, 2017, 115(1): 84-89.
23. Coriddi M, Skoracki R, Eiferman D. Vascularized jejunal mesenteric lymph node transfer for treatment of extremity lymphedema. Microsurgery, 2017, 37(2): 177-178.
24. Daniel BW, Sonnenberg AM, Stern JE, et al. Intra-abdominal lymph node flaps in lymphedema therapy: An anatomical guide to donor site selection. J Surg Oncol, 2022, 125(2): 134-144.
25. Ruter D, Chen W, Garza R 3rd, et al. Mesoappendix as potential donor site for vascularized lymph node transfer: anatomic study. J Surg Res, 2018, 230: 143-147.
26. Grünherz L, Barbon C, von Reibnitz D, et al. Analysis of different outcome parameters and quality of life after different techniques of free vascularized lymph node transfer. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101934. doi: 10.1016/j.jvsv.2024.101934.
27. Maruccia M, Giudice G, Ciudad P, et al. Lymph node transfer and neolymphangiogenesis: from theory to evidence. Plast Reconstr Surg, 2023, 152(5): 904e-912e.
28. Shrout MA, Plonkowski AT, Morris BE, et al. Radiographic enhancement of lymph nodes 9 months after omental lymph node transfer. Plast Reconstr Surg Glob Open, 2024, 12(11): e6305. doi: 10.1097/GOX.0000000000006305.
29. Elia R, Chen HC, Cazzato G, et al. Evaluation of modulation of immunity by lymph node transfer: A preliminary histological evidence in lymphedema patients. Microsurgery, 2024, 44(1): e31123. doi: 10.1002/micr.31123.
30. Ciudad P, Kiranantawat K, Sapountzis S, et al. Right gastroepiploic lymph node flap. Microsurgery, 2015, 35(6): 496-497.
31. Ciudad P, Huayllani MT, Forte AJ, et al. Vascularized lymph node transfer for the treatment of posttraumatic lower extremity lymphedema: a preliminary report. Indian J Plast Surg, 2022, 55(1): 97-101.
32. Ciudad P, Agko M, Perez Coca JJ, et al. Comparison of long-term clinical outcomes among different vascularized lymph node transfers: 6-year experience of a single center’s approach to the treatment of lymphedema. J Surg Oncol, 2017, 116(6): 671-682.
33. Ciudad P, Manrique OJ, Date S, et al. A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience. J Surg Oncol, 2017, 115(1): 37-42.
34. Brown S, Mehrara BJ, Coriddi M, et al. A prospective study on the safety and efficacy of vascularized lymph node transplant. Ann Surg, 2022, 276(4): 635-653.
35. Ciudad P, Manrique OJ, Date S, et al. Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema. Microsurgery, 2017, 37(7): 771-779.
36. Elia R, Chen HC, Taranto GD, et al. Gastroepiploic vascularized lymph node transfer for extremities’ lymphedema: Is two better than one? A retrospective case-control study. J Plast Reconstr Aesthet Surg, 2022, 75(9): 3129-3137.
37. Li Y, Dong R, Li Z, et al. Intra-abdominal vascularized lymph node transfer for treatment of lymphedema: A systematic literature review and meta-analysis. Microsurgery, 2021, 41(8): 802-815.
38. Kumagai Y, Ishiguro T, Haga N, et al. Hemodynamics of the reconstructed gastric tube during esophagectomy: assessment of outcomes with indocyanine green fluorescence. World J Surg, 2014, 38(1): 138-143.
39. Dayan JH, Voineskos S, Verma R, et al. Managing venous hypertension in vascularized omentum lymphatic transplant: restoring bidirectional venous drainage. Plast Reconstr Surg, 2018, 141(2): 326e-327e.
40. Johnson AR, Bravo MG, Granoff MD, et al. Flow-through omental flap for vascularized lymph node transfer: a novel surgical approach for delayed lymphatic reconstruction. Plast Reconstr Surg Glob Open, 2019, 7(9): e2436. doi: 10.1097/GOX.0000000000002436.
41. Lee BS, Granoff MD, Pardo J, et al. Flowthrough omental flap for vascularized lymph node transplant of the lower extremity. Plast Reconstr Surg, 2022, 149(3): 542e-546e.
42. Schaverien MV, Hofstetter WL, Hall MS, et al. Jejunal mesenteric vascularized lymph node transplantation for lymphedema: outcomes and technical modifications. Plast Reconstr Surg, 2022, 149(4): 700e-710e.
43. Kraft CT, Eiferman D, Jordan S, et al. Complications after vascularized jejunal mesenteric lymph node transfer: A 3-year experience. Microsurgery, 2019, 39(6): 497-501.
44. Lo Torto F, Kaciulyte J, Di Meglio F, et al. Orthotopic vascularized lymph node transfer in breast cancer-related lymphedema treatment: Functional and life quality outcomes. Microsurgery, 2024, 44(2): e31147. doi: 10.1002/micr.31147.
45. Manrique OJ, Bustos SS, Kapoor T, et al. Gastroepiploic vascularized lymph node transfer for the treatment of extremity lymphedema: comparison between middle and distal inset. Gland Surg, 2020, 9(2): 528-538.
46. Ciudad P, Manrique OJ, Date S, et al. Simultaneous vascularized lymph node transfer and carpal tunnel release for treatment of advanced stage of breast cancer-related lymphedema with carpal tunnel syndrome. Microsurgery, 2017, 37(6): 745-746.
47. Fuse Y, Fanning JE, Boyd T, et al. The Kager triangle: An anatomic review and potential implications for lymphatic surgery. Plast Reconstr Surg Glob Open, 2025, 13(5): e6791. doi: 10.1097/GOX.0000000000006791.
48. 邓呈亮, 陈君哲, 章一新. 继发性肢体淋巴水肿的外科整合治疗. 中华损伤与修复杂志(电子版), 2024, 19(3): 185-191.
49. Di Taranto G, Bolletta A, Chen SH, et al. A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy. Microsurgery, 2021, 41(1): 34-43.
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Advances in intra-abdominal vascularized lymph node transfer for treatment of limb lymphedema

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