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Quantifying Lymph Nodes During Lymph Node Transplantation: The Role of Intra-operative Ultrasound
Dhruv Singhal, MD, Elizabeth Vorhis, MD, Mandee Hahamoff, BS, Patricia Abbitt, MD, Walter Drane, MD, Beau Toskich, MD.
University of Florida School of Medicine, Gainesville, FL, USA.

PURPOSE: Quantifying lymph nodes in lymph node transplant (LNT) has been performed utilizing pre-operative percutaneous ultrasound. We hypothesize that intra-operative ultrasound (IOU) during LNT would provide a superior method to quantify lymph nodes in our flaps.
METHODS: A prospectively collected database of patients undergoing LNT from September 2014 to August 2015 was reviewed. Our radiologists performed IOU after flap harvest and prior to pedicle ligation to quantify the number of lymph nodes in our flaps.
RESULTS:Eleven patients with an average age of 59 years and a mean BMI 34 underwent LNT for chronic lymphedema during the study period. The patients’ lymphedema was staged Campisi 1 (n=1), 2 (n=4), 3 (n=4), and 4 (n=2). Ten patients underwent transfer of a superficial circumflex iliac artery (SCIA) flap to the upper extremity and one patient underwent a transverse cervical artery (TCA) flap to the lower extremity. The average number of lymph nodes transferred per IOU was 5.8 nodes (range 2-6) for the SCIA flap and 4.0 for the TCA flap.
CONCLUSION: The number of lymph nodes identified utilizing IOU during LNT is significantly higher than those reported by percutaneous ultrasound. Higher resolution with IOU accounts for the increased accuracy of this technique. As there is no data correlating the number of lymph nodes transferred and outcomes following LNT, developing a precise method of quantification is important.


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