Najjar Marc, Lopez Marcos M, Ballestin Alberto, Munabi Naikhoba, Naides Alexandra I, Noland Roberto Daniel, Blackburn Collin, Akelina Yelena, Ascherman Jeffrey A
From the Division of Plastic Surgery, Department of Surgery, and the Department of Orthopaedic Surgery, Columbia University; the Microsurgery Unit, Jesús Usón Minimally Invasive Surgery Centre; and the Division of Plastic and Reconstructive Surgery, University of Southern California.
New York, N.Y.; Los Angeles, Calif.; and Cáceres, Spain.
Plast Reconstr Surg. 2018 Oct;142(4):503e-508e. doi: 10.1097/PRS.0000000000004760.
Vascularized lymph node transfer has recently received attention as a potential surgical treatment for lymphedema. Despite good results in some series, the mechanism and benefits of vascularized lymph node transfer have yet to be fully understood. This study aimed to investigate the reestablishment of drainage into transferred lymph nodes following vascularized lymph node transfer in a rat model.
Seven rats underwent vascularized lymph node transfer. The operation performed on each rat consisted of two parts. First, the left groin lymph node basin with superficial epigastric vessels was harvested as a free flap. Second, the flap was reattached in the left groin of the rat by means of end-to-end microvascular anastomoses. Anastomosis patency was assessed immediately postoperatively and at the time of animal sacrifice. The rats were evaluated for reestablishment of lymphatic flow into the transplanted nodes at 1-month intervals for at least 6 months postoperatively. This was accomplished noninvasively by injecting the rats in their flanks with fluorescent indocyanine green, which was detected using a Photodynamic Eye infrared camera.
Anastomoses were patent in all seven rats immediately postoperatively. No indocyanine green uptake was seen in the transplanted lymph node basins in the first 2 months postoperatively in any of the rats. In five of seven rats, however, indocyanine green uptake was demonstrated in the transplanted lymph node basin by 6 months (average, 13 weeks).
The authors report uptake of indocyanine green in five of seven rats at an average of 13 weeks after lymph node transplantation, consistent with the reestablishment of lymphatic drainage into the transplanted nodes.
带血管蒂淋巴结转移术作为一种潜在的治疗淋巴水肿的手术方法，近来受到关注。尽管在一些系列研究中取得了良好效果，但带血管蒂淋巴结转移术的机制和益处尚未完全明了。本研究旨在探讨大鼠模型中带血管蒂淋巴结转移术后移植淋巴结引流的重建情况。
对7只大鼠进行带血管蒂淋巴结转移术。每只大鼠的手术包括两个部分。首先，切取带有腹壁浅血管的左侧腹股沟淋巴结区作为游离皮瓣。其次，通过端对端微血管吻合将皮瓣重新附着于大鼠左侧腹股沟。术后即刻及处死动物时评估吻合口通畅情况。术后至少6个月，每隔1个月评估大鼠移植淋巴结淋巴回流的重建情况。通过向大鼠侧腹注射荧光吲哚菁绿，然后使用光动力眼红外相机进行检测，以非侵入性方式完成评估。
所有7只大鼠术后即刻吻合口均通畅。术后前2个月，所有大鼠的移植淋巴结区均未见吲哚菁绿摄取。然而，7只大鼠中有5只在术后6个月（平均13周）时，移植淋巴结区出现了吲哚菁绿摄取。
作者报告称，7只大鼠中有5只在淋巴结移植后平均13周出现吲哚菁绿摄取，这与移植淋巴结淋巴引流的重建情况相符。
