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Is More Better? The Number of Lymph Nodes in the Vascularized Lymph Node Transfer Influences its Lymphaticovenous Drainage
Maria Madajka, PhD, Grzegorz Kwiecien, MD, Bahar Bassiri Gharb, MD, PhD, Kashyap Tadisina, BS, Judy Drazba, PhD, James E. Zins, MD, Graham S. Schwarz, MD.
Cleveland Clinic
2015-03-13
Presenter: Susan Orra
Affidavit:
Presented abstract represents entirely the original work of the resident
Director Name: James Zins
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
INTRODUCTION: Vascularized lymph node (VLN) transfer is a promising treatment for lymphedema. Despite positive preliminary outcomes, the mechanism of action and optimal flap design remain unknown. We aimed to: 1) evaluate the mechanism of lymph drainage through VLN flaps, and 2) investigate if the number of VLNs impacts lymph transit through the flap.
METHODS: Twenty-seven axillary VLN flaps were elevated in 14 Sprague-Dawley rats (450-500g) and divided into 3 groups (n=9 each): Group-1 (0 VLNs), Group-2 (2 VLNs), and Group-3 (4 VLNs). Indocyanine green (n=8/group) and Alexa680-albumin (n=1/group) were injected into the edge of flaps and latency period between injection and fluorescence in the axillary vein was recorded. Stereomicroscopic fluorescent lymphography was performed to directly visualize lymphatic transit through the VLNs.
RESULTS: Fluorescence was detected in the axillary vein after 197±188, 109±97, and 73±57 seconds in Group-1, 2, and 3, respectively. There was a negative correlation between the number of VLNs and the latency period (Pearson's r =-0.39; p=0.03). Flap weights were comparable in Group-1, 2, and 3 (275±54, 298±74, 309±60 mg; ANOVA p=0.54). Stereoscopic lymphography allowed direct visualization of lymphatic transit through VLNs into the venous system.
CONCLUSIONS: Lymphatic fluid in VLN flaps drains into the venous system mainly by passing through the afferent lymphatics and VLNs. A secondary mechanism is the diffusion directly into the venous system via flap capillary lymphatics. This is shown by the delayed presence of fluorescence in the pedicle vein in flaps without VLNs. Increasing the number of VLNs improves flap lymphatic drainage capacity.
