ABSTRACT
Introduction: Lymphaticovenular anastomosis (LVA) has been described as a treatment of chronic lymphoedema. This microsurgical technique is new and technically difficult. The small caliber and thin wall lymphatic vessels are difficult to identify and easily destroyed during the dissection. Materials and Methods: We describe a technique of performing lymphaticovenular anastomosis with patent blue dye enhancement. Our patient is a 50-year-old lady who suffers from chronic lymphoedema of the upper limb after mastectomy and axillary clearance for breast cancer 8 years ago. Results: Patent blue dye is injected subdermally and is taken up readily by the draining lymphatic channels. This allows for easy identification of their course. The visualisation of the lumen of the lymphatic vessel facilitates microsurgical anastomosis. The patency of the anastomosis is also demonstrated by the dynamic pumping action of the lymphatic within the vessels. Conclusion: Patent blue dye staining during lymphaticovenular anastomosis is a simple, effective and safe method for mapping suitable subdermal lymphatics, allowing for speedier dissection of the lymphatic vessels intraoperatively. This technique also helps in the confirmation of the success of the lymphaticovenular anastomosis.
In the field of plastic surgery, a novel technique of supermicrosurgery has radically changed many concepts of microsurgery. Lymphaticovenular anastomosis (LVA) has been described as a treatment for primary and secondary lymphoedema in the extremities.1 However, a lymphatic vessel of 0.5 to 0.8 mm diameter is always difficult to identify with precision. As such, multiple lymphatic channels may be accidentally destroyed during the dissection phase and the time for identifying the subdermal lymphatics can be unduly long. We describe a technique of using patent blue dye for lymphatic enhancement during LVA.
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