A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap

Introduction: The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, anatomic variability exists, making the harvest of this flap challenging. Knowledge and characterization of anatomic variability can aid the surgeon in safe and effective flap harvest. Methods: A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed anatomic drawings of each case were reviewed to accurately account for anatomic variability and details. Results: Forty-two patients were identified during the study period. Arteriovenous anatomic variability (A1–A2 and V1–V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course (P < 0.01). Conclusions: The VSLN flap can be safely and effectively harvested with knowledge of arteriovenous anatomic variability. Most commonly, the artery and vein travel together superior to the submandibular gland, but other variations exist, which may add time to surgical flap harvest and increased need for dissection. J. Surg. Oncol. 2017;115:43–47.