Article
The Mechanism of Vascularized Lymph Node Transfer for Lymphedema – Natural Lymphatico-Venous Drainage
Search Medline for
Authors
Published: | September 10, 2013 |
---|
Outline
Text
Purpose: Transfer of vascularized lymph node flaps for treatment of postoperative and postradiation lymphedema is a relatively new, but encouraging method. The purpose was to investigate the mechanism and potency of lymph drainage of these flaps.
Materials and Methods: Indocyanine green fluorescence imaging was used to inject fluorescent dye either into subcutaneous soft tissue (Rat-sc group) or directly into lymph node (Rat-LN group) of each 12 adipous groin lymph node flaps in 3-month-old SD rats. 12 adipocutaneous non-lymph node containing DIEP flaps (Rat-NLN group) were injected as negative control. In clinical part vascularized submental lymph node flaps were accordingly injected either in subcutaneous soft tissue (Clin-sc group) or lymph node directly (Clin-LN group) and non-lymph node containing ALT and forearm flaps were used as negative control (Clin-NLN group).
Results: All LN containing flaps in experimental and clinical groups showed drainage of the ICG dye via the pedicle vein. Detection in Rat-LN group with 12.8±8.1 sec (±SD) and Clin-LN group with 23.7±28.9 sec (±SD) was significantly earlier than in corresponding Rat-SC group with 147.3±133.7 sec (±SD) and Clin-SC group with 500±494.5 sec (±SD). In Rat-NLN group and Clin-NLN groups there was no drainage of the dye over the pedicle veins.
Discussion: The findings of animal as well as clinical part of the study verify the mechanism of lymphatico-venous drainage as potent in vascularized lymph node flaps for transporting interstitial lymphedema fluid into venous system. This supports the already reported positive clinical outcome results of this operation method.