Abstract
Background The aim of our study was to evaluate a new propeller vascularized lymphatic tissue
flap (pVLNT) combined with aligned nanofibrillar collagen scaffolds (CS) (BioBridge)
in reducing lymphedema in the rat lymphedema model.
Methods Unilateral left hindlimb lymphedema was created in 15 female Sprague–Dawley rats
following inguinal and popliteal lymph nodes (LN) resection and radiation. An inguinal
pVLNT was elevated from the contralateral groin and transferred through a skin tunnel
to the affected groin. Four collagen threads were attached to the flap and inserted
in the hindlimb at the subcutaneous level in a fan shape. The three study groups consisted
of group A (control), group B (pVLNT), and group C (pVLNT + CS). Volumetric analysis
of both hindlimbs was performed using micro-computed tomography imaging before the
surgery (at initial time point) and then at 1 and 4 months, postoperatively, and the
relative volume difference (excess volume) was measured for each animal. Lymphatic
drainage was assessed by indocyanine green (ICG) fluoroscopy for number and morphology
of new collectors and the time required for ICG to move from injection point to the
midline.
Results Four months after the induction of lymphedema, an increased relative volume difference
remained in group A (5.32 ± 4.74%), while there was a significant relative volume
reduction in group B (−13.39 ± 8.55%) and an even greater reduction in group C (−14.56 ± 5.04%).
ICG fluoroscopy proved the functional restoration of lymphatic vessels and viability
of pVLNT in both B and C groups. Notably, only group C demonstrated statistically
significant improvements in lymphatic pattern/morphology and in the number of lymphatic
collectors as compared with the control group A.
Conclusion The pedicle lymphatic tissue flap combined with SC is an effective procedure for
the treatment of lymphedema in rats. It can be easily translated into treatment of
humans' lower and upper limb lymphedema and further clinical studies are warranted.
Keywords
lymphedema - vascularized lymph node transfer - collagen scaffolds - guided lymphangiogenesis
