Patent blue dye in lymphaticovenular anastomosis.
BACKGROUND
Lymphaticovenular anastomosis (LVA) has been described as a treatment of chronic lymphoedema. This microsurgical technique is new and technically difficult. The small caliber and thin wall lymphatic vessels are difficult to identify and easily destroyed during the dissection.


METHODS
We describe a technique of performing lymphaticovenular anastomosis with patent blue dye enhancement. Our patient is a 50-year-old lady who suffers from chronic lymphoedema of the upper limb after mastectomy and axillary clearance for breast cancer 8 years ago.


RESULTS
Patent blue dye is injected subdermally and is taken up readily by the draining lymphatic channels. This allows for easy identification of their course. The visualisation of the lumen of the lymphatic vessel facilitates microsurgical anastomosis. The patency of the anastomosis is also demonstrated by the dynamic pumping action of the lymphatic within the vessels.


CONCLUSIONS
Patent blue dye staining during lymphaticovenular anastomosis is a simple, effective and safe method for mapping suitable subdermal lymphatics, allowing for speedier dissection of the lymphatic vessels intraoperatively. This technique also helps in the confirmation of the success of the lymphaticovenular anastomosis.
Yap
Yan Lin
YL
Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital, Singapore.
Lim
Jane
J
Shim
Timothy W H
TW
Naidu
Shenthilkumar
S
Ong
Wei Chen
WC
Lim
Thiam Chye
TC
D000714:Anastomosis, Surgical / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008408:Mastectomy / Q000009:adverse effects; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy
D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; C008769:sulfan blue