Summary
Background
The restoration of the lymphatic function in chronic lymphoedemas can be achieved
by microsurgical lymphatic vessel transplantation. Usually, end-to-end anastomoses
are performed between the lymphatic vessels. Sometimes, the lack of appropriate lymphatic
recipient vessels impels the idea of connecting the grafts to local lymph nodes. This
study focusses on the microsurgical completion of durable lympho-lymphonodular anastomoses
and further the detection of a spontaneous formation.
Methods
In 36 Sprague-Dawley rats the retroperitoneal lymphatic structures were prepared after
staining with patent blue V dye. In group A (n = 12), the left lumbar trunk was cut cranially and its distal part was turned over
to the right lumbar lymph node where a microsurgical lympho-lymphonodular anastomosis
was performed. In group B (n = 12), treatment was similar but without anastomosing. In group C (n = 12), the left lumbar trunk was transected and the capsule of the contralateral
lumbar lymph node was incised. Finally, the lumbar region was re-exposed and the lymphatic
drainage was examined using patent blue in four animals of each group after 8, 12
and 16 weeks, respectively, to examine the development of possible spontaneous formations
of lymphatic connections.
Results
In 12/12 animals of group A, patent transposed lymph vessels and anastomoses with
blue staining of the right lumbar lymph node were observed. Only 1/12 animals of group
B and 2/12 animals of group C showed a blue staining of the right lumbar lymph node.
Conclusions
The microsurgical fabrication of lympho-lymphonodular anastomoses leads to a safe
and durable lymphatic connection. The known plasticity of lymphatic vessels with the
potential of spontaneous anastomosing seems to be higher between lymphatic vessels
than between lymphatic vessels and a lymph node.
Keywords
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References
- Lymphedema. A comprehensive review.Ann Plast Surg. 2007; 59: 464-472
- Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer.J Plast Reconstr Aesthet Surg. 2011; ([Epub ahead of print])
- Popliteal lymphatico-venous anastomosis for lower limb lymphedema to allow patients to adopt the traditional Japanese “seiza” sitting position.J Plast Reconstr Aesthet Surg. 2011; ([Epub ahead of print])
- Microsurgical lymphaticovenous implantation for the treatment of chronic lymphedema.Plast Reconstr Surg. 1998; 101: 157-161
- Ultrastructural observations of lymphatic vessels in lymphedema in human extremities.Plast Reconstr Surg. 1996; 97: 397-405
- Die mikrochirurgische lymphgefaesstransplantation.Handchir Mikrochir Plast Chir. 2003; 35: 202-209
- Transplantation of lymph vessels on rats as well as a first therapeutic application on the experimental lymphedema of the dog.Eur Surg Res. 1980; 12: 7-8
- Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema.World J Surg. 1981; 5: 401-407
- A microsurgical method for reconstruction of interrupted lymphatic pathways: autologous lymph-vessel transplantation for treatment of lymphedemas.Scand J Plast Reconstr Surg. 1986; 20: 141-146
- Technique and proof of patency of microsurgical lympho-lymphonodular anastomoses: a study in the rat model.Microsurgery. 2009; 29: 303-309
- Lymphangiogenesis following obstruction of large postnodal lymphatics in sheep.Microvasc Res. 2007 May; 73: 214-223
- Untersuchungen zum verhalten von resorbierbarem und nicht resorbierbarem Nahtmaterial bei der lymphgefäßnaht.Handchirurgie. 1982; 14: 87-91
- Überbrückung eines lymphgefäßdefektes mittels veneninterposition.Handchir Mikrochir Plast Chir. 1982; 14: 83-86
- Lymphedema and microsurgery.Microsurgery. 2002; 22: 74-80
- Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study.Eur J Nucl Med Mol Imaging. 2003; 30: 202-206
- Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema.Plast Reconstr Surg. 2009 Sep; 124: 777-786
- Lymph node transfer for the treatment of obstructive lymphoedema in the canine model.Br J Plast Surg. 1990 Sep; 43: 578-586
- Follow-up study of upper limb lymphedema patients treated by microsurgical lymphaticovenous implantation (MLVI) combined with compression therapy.Microsurgery. 2003; 23: 21-26
- Sentinel lymph node detection in skin cancer patients using real-time fluorescence navigation with indocyanine green: preliminary experience.J Plast Reconstr Aesthet Surg. 2009; 62: 373-378
Article info
Publication history
Published online: December 02, 2011
Accepted:
November 8,
2011
Received:
July 20,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
