title: Intratissue lymphovenous communications in the mechanism of action of vascularized lymph node transfer.
abstract: OBJECTIVE
  Vascularized lymph node transfer (VLNT) as a surgical treatment for cancer-related lymphedema has shown beneficial effects. The mechanism of action of this procedure involves lymphangiogenesis and lymphovenous communications (LVC) within the lymph nodes. We propose intratissue LVC as an additional element responsible for drainage of lymph to blood in the flap and examine this hypothesis in the current study.
  
  
  METHODS
  This prospective study determined the passage of lymph to the venous system via intratissue LVC in 26 free flaps used for breast reconstruction. We evaluated whether fluorescence was positive in the pedicle vein after increasing time intervals following intradermal injection of indocyanine green (ICG) dye into the flaps using near infra-red fluorescence lymphography.
  
  
  RESULTS
  We studied 26 free flaps, 22 deep inferior epigastric perforator (DIEP) flaps (84.6%), and 4 superior gluteal artery perforator (SGAP) flaps (15.4%). Fluorescence in the pedicle vein was positive in 22 of the 26 flaps (P = 0.000). The median time for fluorescence evaluation in the pedicle vein was 120 min.
  
  
  CONCLUSIONS
  Fluorescence in the pedicle vein after ICG intradermal injection indicates functional intratissue LVC in free flaps. J. Surg. Oncol. 2017;115:27-31. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Miranda Garcés
authors.affiliation: Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pons
authors.affiliation: Department of Anatomy and Embriology, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Mirapeix
authors.affiliation: Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Masià
mesh_terms: D001940:Breast / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000000981:diagnostic imaging / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery; D008220:Lymphography / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061848:Optical Imaging; D011446:Prospective Studies; D013524:Surgical Flaps / Q000098:blood supply
keywords: breast cancer-related lymphedema; lymphedema; lymphedema surgery; mechanism of action