Reestablishment of Lymphatic Drainage after Vascularized Lymph Node Transfer in a Rat Model

Najjar, Marc; López, Marcos; Ballestín, Alberto; Munabi, Naikhoba C.O.; Naides, Alexandra; Noland, Roberto D.; Blackburn, Collin; Akelina, Yelena; Ascherman, Jeffrey A.

doi:10.1097/prs.0000000000004760

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…The selected time for primary ischemia was 8 hours, based on previous studies and our own research experience with this animal model. 2,11,[14][15][16] Macroscopically, our study results showed a significant decrease in flap survival in the I/R control group compared with the control group (p < 0.05). These results conflicted with the histological findings as higher levels of edema formation (p < 0.05), neutrophil infiltration (p < 0.05), and structural damage were observed in the I/R group than in the control group.…”

Section: Discussionmentioning

confidence: 53%

Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model

Masa

Casado-Pérez

Crespo-Lora

et al. 2020

J Reconstr Microsurg

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Background Ischemia-reperfusion (I/R) injury is a serious condition that can affect the success rate of microsurgical reconstructions of ischemic amputated limbs and complex tissue defects requiring free tissue transfers. The purpose of this study was to evaluate the effects of ischemic preconditioning (IPC) and C1 esterase inhibitor (C1-Inh) intravenous administration following I/R injury in a rat skin flap model. Methods Superficial caudal epigastric skin flaps (3 cm × 7 cm) were performed on 50 Wistar rats that were randomly divided into five groups. Ischemia was not induced in the control group. All other flaps underwent 8 hours of ischemia prior to revascularization: I/R control group (8-hour ischemia), IPC group (preconditioning protocol + 8-hour ischemia), C1-Inh group (8-hour ischemia + C1-Inh), and IPC + C1-Inh group (preconditioning protocol + 8-hour ischemia + C1-Inh). Survival areas were macroscopically assessed after 1 week of surgery, and histopathological and biochemical evaluations were also measured. Results There were no significant differences in flap survival between the treatment groups that were suffering 8 hours of ischemia and the control group. A significant increase in neovascularization and lower edema formation were observed in the IPC group compared with that in the I/R group. Biochemical parameters did not show any significant differences. Conclusion Intravenous administration of C1-Inh did not significantly modulate I/R-related damage in this experimental model, but further research is needed. On the other hand, IPC reduces tissue damage and improves neovascularization, confirming its potential protective effects in skin flaps following I/R injury.

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Section: Discussionmentioning

confidence: 53%

Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model

Masa

Casado-Pérez

Crespo-Lora

et al. 2020

J Reconstr Microsurg

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“…Lymphedema is a chronic condition of lymphatic impairment commonly caused by infection, surgery, or radiation therapy [1][2][3][4]. Inflammation caused by local immune insufficiency and abnormal lipid profiles also result in lymphatic impairment [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Inflammation caused by local immune insufficiency and abnormal lipid profiles also result in lymphatic impairment [5][6][7][8][9]. Disrupted lymphatic flow leads to fluid accumulation in the regional interstitium that could result in cellular proliferation, fibrosis, adipose 상지에서의 혈관성 림프절 전이술의 미용적 삽입을 위한 새로운 수용부: 초기 결과 tissue hypertrophy, and skin breakdown [2,10]. Owing to the chronic edematous conditions and inflammation, the postoperative rehabilitation and quality of life of lymphedema patients, approximately > 250 million worldwide, are affected [2,5].…”

Section: Introductionmentioning

confidence: 99%

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

Yi¹,

Park²,

Seo³

et al. 2021

Arch Hand Microsurg

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Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).Conclusion: The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.

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“…Because of the smaller size of the circumflex superficial iliac artery in mice and to get a VLNT animal model that is technically easy to perform, the lymph node flap has been pedicle, in contrast with free microsurgical transfer recently described in rats. 7 In line with the literature, 5 we decided to apply the contralateral VLNT to the acquired and chronic hindlimb mouse model described by Oashi et al in 2012. 14 As vascular endothelial growth factor (VEGF)-C has been shown to improve lymphangiogenesis in experimental studies, 15,16 we embedded it in gelatin sponges and locally added it to the VLNT to quantify its lymphangiogenic influence.…”

mentioning

confidence: 98%

“…Because of their cost efficiency, mice models are constantly under revision and improvement. 6 One of the major limitations in performing a VLNT hindlimb mouse model is the small size of the vascular pedicle of the lymph node flap, which represents a technical limitation to the achievement of a free vascular anastomosis, in contrast to what has been recently performed on a rat model 7 and what is routinely performed in humans. Until now, to overcome this limitation, VLNT in mice was realized as a pedicle flap harvesting VLNT from inguinal (also called "abdominal") to popliteal in the same paw.…”

mentioning

confidence: 99%

Contralateral Vascularized Lymph Node Transfer: An Optimized Mouse Model

Vottero

Morfoisse

Durré

et al. 2019

J Reconstr Microsurg Open

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Background Vascularized lymph node transfer (VLNT) is one of the surgical options in the treatment of lymphedema, but its mechanism of action has not yet been firmly clarified. In the VLNT mouse models described so far, the lymph node flap is performed between two different sites in the same lymphedematous paw. In this study, we describe an optimized VLNT mouse model using the contralateral paw as donor site, thus removing the bias of transferring a lymph node already damaged by irradiation and/or surgery required to induce lymphedema. Methods A lymphedema was induced on the left posterior paw in four experimental groups of mice (n = 8). Two weeks later, group 1 was the sham one, group 2 underwent a VLNT from the right inguinal region to the left, in group 3 a vascular endothelial growth factor (VEGF)-C sponge was placed alone in the left inguinal region, and in group 4 a VEGF-C sponge was associated to the VLNT. The 32 mice were followed during 3 months. Outcomes included paws volume, skin quality, inflammation in the lymphedematous tissue, and lymphatic network density and function. Results Group 4 displayed significantly higher (p < 0.05) lymphedema regression compared with the other three groups. Conclusions This optimized mouse model of VLNT shows to be handy and effective. It could be exploited to perform further experimental studies about the influence of VLNT on lymphedema. Moreover, the local association between VLNT and biological compounds in this model allows it to be a good preclinical model to identify new potential drugs in lymphedema.

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Reestablishment of Lymphatic Drainage after Vascularized Lymph Node Transfer in a Rat Model

Abstract: 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.

Cited by 17 publications

References 22 publications

Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model

Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model

Novel Recipient Site for Aesthetic Inset of Vascularized Lymph Node Transfer: Preliminary Report

Contralateral Vascularized Lymph Node Transfer: An Optimized Mouse Model

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