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We describe the technique and outcomes of a laparoscopically harvested extended gastroepiploic VLN flap with two levels of inset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Between 2014 and 2015, four\u2010patients with upper limb breast cancer\u2010related lymphedema and three\u2010patients with lower limb pelvic cancer\u2010related lymphedema who underwent VLN transfers were included. After harvest, the gastroepiploic VLN flap was divided into two halves that were separately inset at the level of elbow and wrist (upper limb) or knee and ankle (lower limb). The mean patient age was 53.1 years (range, 42\u201365 years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average flap size after division was 6.3 cm in length (range, 5\u20137 cm) and 3.4 cm in width (range, 3\u20134 cm). The mean pedicle length was 3.2 cm (range, 2.5\u20134 cm). All flaps survived completely. No donor or recepient site complication was noted. At a mean follow\u2010up of 9.7 months (range, 8\u201311 months), the mean circumference reduction rate was 43.7\u2009\u00b1\u20092.5% along the entire limb (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). No episode of infection was noted postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Double gastroepiploic VLN transfers to middle and distal limb are a safe approach with very promising results. This technique may be used to improve clinical outcomes by enhancing the lymphatic drainage of the entire affected limb in a uniform fashion. In addition, the laparoscopic harvest can provide decreased donor site morbidity with a faster recovery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30168","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T10:35:23Z","timestamp":1490351723000},"page":"771-779","source":"Crossref","is-referenced-by-count":65,"title":["Double gastroepiploic vascularized lymph node tranfers to middle and distal limb for the treatment of lymphedema"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4646-2676","authenticated-orcid":false,"given":"Pedro","family":"Ciudad","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital Taichung Taiwan"},{"name":"Department of Biological Science and Technology China Medical University Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar 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