Background
Lymphedema is characterized by the accumulation of lymphatic fluid in a given body part. Lymphovascular transplant surgery has become one of the main modalities in its treatment, but there is still no consensus on the ultimate donor sites. This study shares our experience with vascularized lymph node transplant surgery using nodes harvested from two different anatomical locations in the neck.

Objective
The aim was to determine the outcomes of patients managed by vascularized lymph node transplant surgery using lymphovascular tissues from the submandibular and supraclavicular donor sites.

Methodology
This was a comparative study conducted at Kenyatta National Hospital, a tertiary referral center in Kenya, between January 2013 and December 2023. All patients had lymphoscintigraphy to confirm the diagnosis of lymphedema. Patients were divided into two groups based on donor sites: the submandibular group (sMn) and the supraclavicular group (sCn). Limb girths were measured prior to surgery and patients were followed up at regular intervals for at least one year. Variables considered included length of surgery, number of nodes harvested, reduction in limb girth, and complications.

Results
A total of 44 patients were included, with 24 in the submandibular group and 20 in the supraclavicular group. The patients’ ages ranged from 13 to 67 years, with a mean age of 36.6 years. The mean time for harvesting nodes in the supraclavicular group was 3 hours 19 minutes, while in the submandibular group it was 2 hours 14 minutes. More nodes were harvested from the submandibular group compared to the supraclavicular group, although the difference was not statistically significant.

Conclusion
Both donor sites are effective in the management of lymphedema. However, operative time was significantly shorter in the submandibular group, likely due to the more consistent anatomical location of the blood vessels.