Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France.
J Plast Reconstr Aesthet Surg. 2013 Mar;66(3):382-9. doi: 10.1016/j.bjps.2012.10.019. Epub 2012 Dec 4.
Lymphoedema supermicrosurgery is known to be difficult to perform. Lymphatic vessels are not easy to individualise, because of their small calibre (inferior to 1 mm) and their translucent appearance. Patent blue is an organic colourant, which is able to enhance the lymphatic network. We have evaluated the morbidity and the efficacy of patent blue lymphatic enhancement, with a view to perform lymphaticovenular anastomosis.
From November 2010 to January 2012, 20 patients with chronic lymphoedema of the upper limb were treated by lymphaticovenular anastomosis. The mean age of the patients was 60.1 years (range, 47-78 years). The mean duration of lymphoedema was 3.2 years (range, 1-9 years). The mean volume of patent blue injected subdermally before surgery was 1.3 ml (range, 1-2 ml). The number and the calibre of enhanced lymphatic vessels at each operative site were noted. The quality of patent blue enhancement was analysed. The efficacy of surgery was assessed by quantitative measures.
The mean number of coloured lymphatic vessels per operative site was 2.1 (range, 1-4). The calibre of lymphatic vessels ranged from 0.3 to 0.8 mm (average, 0.57 mm). The quality of enhancement was moderate in two patients (8%), good in nine patients (36%) and excellent in 14 patients (56%). The mean number of lymphaticovenular anastomosis performed per operative site was 2.8 (range, 2-4). The mean operative time was 2.3 h (range, 2-3 h). No allergic (0%) and infectious (0%) reactions secondary to patent blue injection occurred. No secondary lymphangitis (0%) was noted. The delay of skin resorption of the blue stain ranges from 20 to 45 days (average, 30.3 days). Four patients (20%) had a remaining blue staining at the injection site. The average circumferential differential reduction rate was 13.2% (range, 4.2-27.2%) (p<0.001). The average cross-sectional area differential reduction rate was 24.1% (range, 9.5-46.7%) (p<0.001). The average volume differential reduction rate was 22.8% (range, 7.2-48.8%) (p<0.001).
Patent blue-enhanced lymphaticovenular anastomosis is a safe and effective technique to treat patients with secondary lymphoedema. Its ease of use, low cost and efficiency should make it used on a priority basis to perform lymphaticovenular anastomosis.
淋巴水肿超显微外科手术难度较大。淋巴管口径小（小于 1 毫米）且呈半透明状，不易单独识别。专利蓝是一种有机着色剂，能够增强淋巴管网络。我们评估了专利蓝淋巴增强的发病率和疗效，以期进行淋巴管静脉吻合术。
从 2010 年 11 月至 2012 年 1 月，20 例上肢慢性淋巴水肿患者接受了淋巴管静脉吻合术治疗。患者平均年龄 60.1 岁（范围，47-78 岁）。淋巴水肿的平均病程为 3.2 年（范围，1-9 年）。手术前皮下注射专利蓝的平均体积为 1.3 毫升（范围，1-2 毫升）。记录每个手术部位增强淋巴管的数量和口径。分析专利蓝增强的质量。通过定量测量评估手术效果。
每个手术部位的彩色淋巴管平均数量为 2.1（范围，1-4）。淋巴管口径范围为 0.3 至 0.8 毫米（平均 0.57 毫米）。增强质量为中等的有 2 例（8%），良好的有 9 例（36%），优秀的有 14 例（56%）。每个手术部位的淋巴管静脉吻合术平均数量为 2.8（范围，2-4）。手术平均时间为 2.3 小时（范围，2-3 小时）。专利蓝注射无过敏（0%）和感染（0%）反应。未观察到继发性淋巴管炎（0%）。蓝色染色皮肤吸收延迟时间为 20 至 45 天（平均 30.3 天）。4 例（20%）患者在注射部位仍有蓝色染色。平均周长差异减少率为 13.2%（范围，4.2-27.2%）（p<0.001）。平均横截面积差异减少率为 24.1%（范围，9.5-46.7%）（p<0.001）。平均体积差异减少率为 22.8%（范围，7.2-48.8%）（p<0.001）。
专利蓝增强淋巴管静脉吻合术是治疗继发性淋巴水肿患者的一种安全有效的技术。其使用方便、成本低、效率高，应优先用于淋巴管静脉吻合术。
