The mechanism of vascularized lymph node transfer for lymphedema: natural lymphaticovenous drainage.
BACKGROUND
Vascularized lymph node flap transfer for the treatment of upper and lower limb lymphedema has had promising results. This study was performed to investigate the mechanism of lymph drainage of a vascularized lymph node flap both experimentally and clinically.


METHODS
In the experimental study, 18 Sprague-Dawley rats were used to create 36 flaps, either a groin lymph node flap or an abdominal cutaneous flap that did not contain lymph nodes. Indocyanine green dye was injected into the edge of 12 lymph node flaps, directly into a lymph node of 12 lymph node flaps, and into the edge of 12 cutaneous flaps. In the clinical study, an identical study design was used, with 24 vascularized lymph node flaps and 12 cutaneous flaps not containing lymph nodes.


RESULTS
Experimentally, fluorescence was detected in the pedicle vein after a mean latency period of 153 ± 129 seconds when the edge of the lymph node flap was injected and 12.8 ± 8.1 seconds when the lymph node was directly injected. Fluorescence was not detected in the pedicle vein of the cutaneous flaps (p < 0.01). Clinically, fluorescence was detected in the pedicle vein after a mean latency period of 346 ± 249 seconds when the edge of the lymph node flap was injected and 23.5 ± 27.1 seconds when the lymph node was directly injected. Fluorescence was not detected in the pedicle vein of the cutaneous flaps (p < 0.01).


CONCLUSIONS
The vascularized lymph node flap drains lymph into the pedicle vein, both experimentally and clinically.


METHODS
Therapeutic, V.
Taoyuan, Taiwan; Austin, Texas; and Ludwigshafen, and Heidelberg, Germany From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine; Seton Institute of Reconstructive Plastic Surgery; Department of Hand and Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center; and Department of Plastic Surgery, University of Heidelberg.
Ming-Huei
MH
Cheng
Jung-Ju
JJ
Huang
Chih-Wei
CW
Wu
Chin-Yu
CY
Yang
Chia-Yu
CY
Lin
Steven L
SL
Henry
Leila
L
Kolios
D000818:Animals; D004322:Drainage / Q000379:methods; D008196:Lymph; D008198:Lymph Nodes / Q000098:blood supply* / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013524:Surgical Flaps; D014680:Veins