Preplanning Vascularized Lymph Node Transfer with Duplex Ultrasonography: An Evaluation of 3 Donor Sites

BACKGROUND As experience with vascularized lymph node (VLN) transfer has grown, new VLN sources have become apparent. Descriptive studies have elucidated variable lymph node presence in these donor basins. Yet, no study has evaluated preoperative imaging evaluation between donor sites in patients undergoing VLN transfer. This study was to compare the findings on duplex ultrasonography of the submental, groin, and supraclavicular lymph node basins in patients undergoing VLN transfer. METHODS A review of a prospective database was performed for patients who had undergone preoperative planning for VLN transfer with duplex ultrasonography to provide objective donor-site characteristics. Multiple regression analysis was used to identify factors that correlated with specific flap characteristics. A P value less than 0.05 was considered statistically significant. RESULTS Sixty-eight patients (28 upper extremities and 40 lower extremities) were identified as undergoing preoperative duplex ultrasonography for VLN transfer. Little variation was seen when evaluating donor sites for laterality in patients. Groin and submental VLN sites had 3.1 and 3.3 lymph nodes, respectively, compared with 0.9 lymph nodes in the supraclavicular donor site (p < 0.01). Increasing age had an inverse relationship with estimated flap volume, whereas higher body mass index correlated with increasing flap thickness. CONCLUSIONS Preoperative imaging with duplex ultrasonography before VLN transfer may allow for accurate identification of specific VLN donor-site characteristics. When considering lymph node-specific characteristics, higher quantity of lymph nodes were found on the groin and submental flap axis compared with the transverse cervical artery axis.