Supramicrosurgical lymphatic‐venous anastomosis for postsurgical subcutaneous lymphocele treatment

Abstract

Postsurgical subcutaneous lymphocele is caused by accidental lesion of a lymphatic vessel that keeps on flowing lymph under the scar. Traditional treatments include aspiration and compression, with probable recurrence, and sclerotherapy which destroys both lymphatic cyst and vessel, creating risk of lymphedema. We describe the case of a postsurgical subcutaneous lymphocele of the left leg that was treated by supramicrosurgical lympatic-venous anastomosis. A single anastomosis was performed end-to-end, between one lymphatic vessel, individuated through indocyanine green lymphography, and one subcutaneous vein, distally to the lymphocele, under sedation and local anesthesia. Postoperative course was uneventful; the lymphocele completely resolved and never recurred during the nine months followup. This technique may heal the lymphocele with no impairing of lymph drainage function.

The lymphatic superficial circumflex iliac vessels deep branch perforator flap: A new preventive approach to lower limb lymphedema after groin dissection‐preliminary evidence

“…The lymphatic function of the limbs was also evaluated by preoperative indocyanine green (ICG) lymphography, according to a method that we routinely employ for lymphedema and lymphocele study, and widely reported in literature (Gentileschi et al, ; Yamamoto et al, ); 0.2 ml of ICG (Verde Indocianina Pulsion, Pulsion Medical Systems AG Sthalgruberring 28 D‐81829 Monaco, Germania) were injected intradermally at the first web space of the foot and at the lateral border of the Achilles tendon at the level of the external malleolus. After injection, dynamic lymphatic vessels images were obtained by an infrared camera system (Photodynamic Eye; Hamamatsu Photonics K.K., Hamamatsu, Japan).…”

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

“…6,16 Inguinal defect was in 20 cases a wide subcutaneous defect following extended groin dissection with 3 of them including also an inguinal skin resection because of proximity of pathologic nodes, and in three cases was caused by the removal of a big lymphocele, developed after groin dissection. 17 Age, height, weight, and body mass index (BMI) of patients were recorded. Every patient had undergone preoperative high-resolution contrast-enhanced total body computed tomography (CT) scan, with focus at the level of genitalia and groins for cancer staging.…”

Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb

“…The preoperative lymphatic mapping of patients was achieved at the moment of ICG lymphography on the day before surgery with a painless injections technique (Visconti, Albanese, & Salgarello, ). The exam was accomplished according to a method widely reported in literature (Yamamoto, Yamamoto, et al, ), routinely employed for Lymphedema and Lymphocele preoperative study (Gentileschi, Servillo, & Salgarello, ; Gentileschi, Servillo, Ferrandina, & Salgarello, ). 0.1 mL of ICG (Verde Indocianina Pulsion, Pulsion Medical Systems AG Sthalgruberring 28D‐81829 Monaco, Germany) was injected intradermal at the second web space of the hand and at the ulnar border of the palmaris longus tendon at the level of the wrist, in both the upper limbs.…”

“…The preoperative lymphatic mapping of patients was achieved at the moment of ICG lymphography on the day before surgery with a painless injections technique (Visconti, Albanese, & Salgarello, 2017). The exam was accomplished according to a method widely reported in literature , routinely employed for Lymphedema and Lymphocele preoperative study (Gentileschi, Servillo, & Salgarello, 2015;Gentileschi, Servillo, Ferrandina, & Salgarello, 2017). The tendon of the palmaris longus muscle, at the level of the wrist, the midpoint of the cubital fossa, and the insertion of the anterior axillary pillar on the arm.…”