Interaction between vascularized lymph node transfer and recipient lymphatics after lymph node dissection - a pilot study in a canine model

Hiroo Suami*, Mario F. Scaglioni, Katherine A. Dixon, Ramesh C. Tailor

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Vascularized lymph node transfer (VLNT) has become more widespread for surgical treatment of lymphedema. However, interaction between a transferred lymph node and the recipient lymphatic system in relieving lymphedema has not been identified. The aims of this study were to investigate anatomic changes in the lymphatic system in the forelimb of a canine after lymph node dissection and irradiation and to clarify the interaction between the transferred lymph node and recipient lymphatics. Materials and methods Two adult female mongrel canines were used for this exploratory study. The unilateral axillary and lower neck node dissections were performed, and 15-Gy irradiation was applied on postoperative day 3. After 1 y, a VLNT flap was harvested from the lower abdominal region and inset in the axilla with vascular anastomoses. The girth of each forelimb was determined with a tape measure at different time points. Indocyanine green fluorescence lymphography and lymphangiography were performed before and after each surgery to evaluate morphologic changes in the lymphatics. Results Both canines revealed identical changes in the lymphatic system, but only one canine developed lymphedema. After lymph node dissection, a collateral lymphatic pathway formed a connection to the contralateral cervical node. After VLNT, an additional collateral pathway formed a connection to the internal mammary node via the transferred node in the axilla. Conclusions The findings suggest that the lymphatic system has a homing mechanism, which allows the severed lymphatic vessels to detect and connect to adjacent lymph nodes. VLNT may create new collateral pathways to relieve lymphedema.

Original languageEnglish
Pages (from-to)418-427
Number of pages10
JournalJournal of Surgical Research
Volume204
Issue number2
DOIs
Publication statusPublished - Aug 2016
Externally publishedYes

Keywords

  • Lymphatic system
  • Lymph node dissection
  • Lymphedema
  • Canine
  • Vascularized lymph node transfer
  • Indocyanine green fluorescence lymphography
  • Lymphangiography

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