Abdominoplasty Access for Desmoid Tumor Resection in the Rectus Abdominis Muscle

451 end-to-side, and the concomitant veins of the radial artery end-to-end. Saaristo et al. [5] combined the breast reconstruction using abdominal flaps with the transfer of vascularized inguinal lymph nodes based on the superficial circumflex iliac vessels or the superficial inferior epigastric vessels, and the anastomoses were performed from the deep inferior epigastric vessels end-to-end to the thoracodorsal vessels. According to the research, there is no consensus on the staging of lymphedema. Only three studies [2-4] have reported precise preop-erative staging systems; however, each study used different criteria. Fifty-seven of 73 patients (78%) had postoperative improvement of the affected limb. In every study, a different postoperative evaluation method was used, and the relationship between the lymph node recipient site (axilla, elbow, or wrist) and the anatomical site with the maximum improvement was not clearly reported. Becker et al. [2] reported that from the 18 patients, the upper limb perimeter returned to normal in 10 cases, remained unchanged in 2 cases, and decreased by more than 50% of its value in 6 patients and less than 50% of its value in 6 other patients. Two years later, Becker et al. [3] evaluated the influence of LNT in postmastectomy neuropathic pain in 6 patients. All of the patients had relief of the symptoms and in 5 patients the lymphedema resolved. Gharb et al. [4] compared the classic groin lymph node flap with a groin flap based on hilar perforators and reported that differences between the preop-erative and postoperative measurements were statistically significant only in the perforator-based group at the levels below the elbow, wrist, and midpalm. Saaristo et al. [5] achieved reduction of the affected limb in 7 of 9 patients. Even though it is implied that at early stage lymphedema, the LNT has better results, the influence of LNT at each stage of lymphedema is not clear. In addition, 17.8% of the patients required an additional procedure (suction assisted lipectomy [SAL] or skin excision) due to lack of sufficient improvement after LNT. According to existing clinical studies, LNT is able to alleviate post-mastectomy upper extremity lymphedema. However, the improvement is variable and no conclusions have been drawn regarding which technique, group of donor lymph nodes, or recipient site can ensure the maximum reduction of the affected limb. More clinical studies are needed, and a consensus about the staging system of lymphedema and the evaluation methods for postop-erative results should be established …