Table 2.

Characteristic of flaps used in VLNT

Donor region	Lymph nodes group	Donor vessels	Advantages	Disadvantages
Groin	Superficial inguinal lymph nodes	Superficial circumflex iliac artery and vain	Possible same-time breast reconstruction; avoidance of additional scar for lymph node harvest Scar hidden by clothing Large skin paddle can be included	Possible iatrogenic lymphedema in the lower limb–evaluation of lymph circulation is required before the procedure Risk of donor-site seroma
Submental	Cervical lymph nodes level Ia/Ib	Submental artery	Low risk for donor-site lymphedema Large number of lymph nodes Small scar hidden in the wrinkles	Variability of anatomy, risk of mandibular nerve injury Risk of submandibular gland injury Partial resection of platysma muscle
Supraclavicular	Cervical lymph nodes level Vb	Branch of transvers cervical vessels; branches of the external jugular vein	Low risk for donor-site lymphedema	Injury of supraclavicular nerve (potential paresthesia) Risk of thoracic duct injury Risk of phrenic nerve injury Risk of Horner syndrome More visible scar
Omental	Omental lymph nodes	Gastroepiploic artery and vein	Low risk for donor-site lymphedema Possible laparoscopic harvest—small scar Large number of lymph nodes	No skin paddle (no possible monitoring of the flap recovery) Possible abdominal complications: hernias, peritonitis, damage of intra-abdominal organs, bowel perforation, internal bleeding Visceral vessels-flaccid pedicle prone to twisting
Mesenteric	Mesenteric lymph nodes	Branches of superior mesenteric artery	Low risk for donor-site lymphedema Possible laparoscopic harvest—small scar Large number of lymph nodes	No skin paddle (no possible monitoring of the flap recovery) Possible abdominal complications: hernias, peritonitis, damage of intra-abdominal organs, bowel perforation, internal bleeding, bowel obstruction Visceral vessels-flaccid pedicle prone to twisting