Efficacy of Vascularized Submental Lymph Node Transfer with Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema

Background: Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. FLE traditionally has been managed with antibiotics and decongestive therapy (DCT) in the early stage or excisional surgery at the late stage. Results of vascularized lymph node transfer (VLNT) in postoncologic lymphedema have been encouraging, and VLNT is a widely accepted surgical treatment. The authors advocate that the combined treatment of antibiotics, DCT, and vascularized submental lymph node (VSLN) transfer could produce objective and subjective improvement of early-stage lower limb FLE. Methods: Between January of 2019 and January of 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. Results: Three men and one woman with an average age of 27 years (range, 25 to 29 years) were included. Two patients presented bilateral lymphedema. One patient was lost at 3-month follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements after antibiotics and DCT of 2074 ± 471 cc (39% ± 9%). At a mean follow-up of 12.3 ± 6.2 months, further improvement of limb volume of 2389 ± 576 cc (45% ± 10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow and none of the patients had episodes of postoperative cellulitis. Patients reported excellent outcome on subjective scoring (average score, 9 ± 1) and returned to their daily activities without wearing compression garments. Conclusion: The authors' early experience showed that VSLN transfer may represent an effective treatment option in the multimodal approach to early-stage lower limb FLE.