Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
J Plast Reconstr Aesthet Surg. 2024 Jun;93:290-298. doi: 10.1016/j.bjps.2024.04.023. Epub 2024 Apr 13.
Lymphaticovenous anastomosis is widely used in lymphedema management. Although its effectiveness in reducing edema in patients can be clinically observed, evaluating the long-term outcomes of this technique can be complex. This study established an animal model to assess the outcomes of lymphaticovenous anastomosis technique at 15 and 30-days post-surgery using indocyanine green lymphography, Patent Blue V dye injection, and histopathological examination.
An experimental model was established in the hindlimbs of 10 rabbits using the popliteal vein and afferent lymphatic vessels in the popliteal area. The subjects were divided into two groups: the first group (n = 5) underwent patency assessment at 0 and 15 days, and the second group (n = 5) at 0 and 30-days, resulting in 20 anastomoses. Patency was verified at 0, 15, and 30-days using indocyanine green lymphography and Patent Blue V injection. Histopathological examinations were performed on the collected anastomosis samples.
The patency rate was 90% (19/20) initially, 60% (6/10) at 15 days post-surgery, and 80% (8/10) at 30-days. The average diameter of lymphatic vessels and veins was 1.0 mm and 0.8 mm, respectively. The median number of collateral veins was 3; the median surgical time was 65.8 min. Histopathology revealed minimal endothelial damage and inflammatory responses due to the surgical sutures, with vascular inflammation and thrombosis in a single case. Local vascular neoformations were observed.
This study highlights the reliability and reproducibility of using rabbits as experimental models for training in lymphaticovenous anastomosis technique owing to the accessibility of the surgical site and dimensions of their popliteal vasculature.
淋巴管静脉吻合术广泛应用于淋巴水肿的治疗。尽管临床观察到该技术可有效减轻患者的水肿，但评估其长期效果较为复杂。本研究建立了一种动物模型，通过吲哚菁绿淋巴造影、专利蓝 V 染料注射和组织病理学检查，在术后 15 天和 30 天评估淋巴管静脉吻合术的效果。
采用兔后肢隐静脉及其腘窝区输入淋巴管，建立实验模型。将 10 只兔随机分为两组：第 1 组（n=5）分别于术后 0 天和 15 天进行通畅性评估，第 2 组（n=5）分别于术后 0 天和 30 天进行通畅性评估，共吻合 20 个吻合口。术后 0 天、15 天和 30 天通过吲哚菁绿淋巴造影和专利蓝 V 染料注射验证吻合口通畅性，采集吻合口标本进行组织病理学检查。
吻合口初始通畅率为 90%（19/20），术后 15 天为 60%（6/10），术后 30 天为 80%（8/10）。淋巴管和静脉的平均直径分别为 1.0mm 和 0.8mm，平均侧支静脉数量为 3 条，手术时间中位数为 65.8min。组织病理学显示，由于手术缝线的存在，吻合口仅有轻微的内皮损伤和炎症反应，1 例可见血管炎症和血栓形成，局部可见新生血管。
本研究表明，由于手术部位易于接近，兔后肢隐静脉及其腘窝区输入淋巴管的尺寸与人体相似，因此可将其作为淋巴管静脉吻合术技术培训的实验模型，具有可靠性和可重复性。
