title: Interaction between vascularized lymph node transfer and recipient lymphatics after lymph node dissection-a pilot study in a canine model.
abstract: Vascularized lymph node transfer (VLNT) has become more widespread for surgical treatment of lymphedema. However, interaction between a transferred lymph node and the recipient lymphatic system in relieving lymphedema has not been identified. The aims of this study were to investigate anatomic changes in the lymphatic system in the forelimb of a canine after lymph node dissection and irradiation and to clarify the interaction between the transferred lymph node and recipient lymphatics.
  
  
  
  Two adult female mongrel canines were used for this exploratory study. The unilateral axillary and lower neck node dissections were performed, and 15-Gy irradiation was applied on postoperative day 3. After 1 y, a VLNT flap was harvested from the lower abdominal region and inset in the axilla with vascular anastomoses. The girth of each forelimb was determined with a tape measure at different time points. Indocyanine green fluorescence lymphography and lymphangiography were performed before and after each surgery to evaluate morphologic changes in the lymphatics.
  
  
  
  Both canines revealed identical changes in the lymphatic system, but only one canine developed lymphedema. After lymph node dissection, a collateral lymphatic pathway formed a connection to the contralateral cervical node. After VLNT, an additional collateral pathway formed a connection to the internal mammary node via the transferred node in the axilla.
  
  
  
  The findings suggest that the lymphatic system has a homing mechanism, which allows the severed lymphatic vessels to detect and connect to adjacent lymph nodes. VLNT may create new collateral pathways to relieve lymphedema.
authors: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: hsuami@hotmail.com.
authors: Hiroo
authors: H
authors: Suami
authors: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Mario F
authors: MF
authors: Scaglioni
authors: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Katherine A
authors: KA
authors: Dixon
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Ramesh C
authors: RC
authors: Tailor
mesh_terms: D000818:Animals; D004285:Dogs; D005260:Female; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000637:transplantation*; D042583:Lymphangiogenesis; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D023421:Models, Animal; D010865:Pilot Projects; D011878:Radiotherapy / Q000009:adverse effects*; D013524:Surgical Flaps / Q000098:blood supply
keywords: Canine; Indocyanine green fluorescence lymphography; Lymph node dissection; Lymphangiography; Lymphatic system; Lymphedema; Vascularized lymph node transfer