VLNT

Vascularized lymph node transfer (VLNT) is a microsurgical procedure used to treat lymphedema by transplanting healthy lymph nodes with their blood supply to the region affected by swelling. The aim is to restore lymphatic drainage and reduce limb volume, often as part of a multimodal approach that includes physical therapy and compression.

In VLNT, a donor lymph node flap is harvested from a region with abundant lymphatic supply and acceptable morbidity, commonly the groin (inguinal region), submental area, or supraclavicular region. The flap is raised with its arterial and venous blood vessels and transplanted to a recipient site near the affected limb, where microsurgical connections are made to local blood vessels to reestablish perfusion. The transferred nodes are intended to integrate into the regional lymphatic system and promote lymphangiogenesis, improving drainage over time. Some centers may combine VLNT with other lymphatic reconstruction techniques.

Indications include secondary lymphedema after cancer treatment (for example breast cancer-related upper limb lymphedema), as well as primary lymphedema or cases where conservative therapy has failed. VLNT is often considered for stage II to III disease, or when patients have recurrent infections or significant functional limitation despite standard therapies.

Outcomes vary by individual and disease severity, but many patients experience limb volume reduction, fewer cellulitis episodes, and improved quality of life. Risks include donor-site morbidity (such as donor-site lymphedema, seroma, or numbness), flap failure, infection, and the potential need for additional procedures. Donor-site selection and oncologic safety considerations are important factors in preoperative planning.

Historically developed in the early 2000s, VLNT has evolved with refinements in donor site selection and surgical technique and is commonly performed as part of a broader, multimodal strategy for lymphedema management.