Abstract
Background Although the usefulness of efferent lymphaticovenular anastomosis (ELVA) in lymphatic
microsurgery has been reported, the optimal method to distinguish efferent from afferent
lymphatics is not yet established. We propose a novel technique to detect efferent
lymphatics appropriate for anastomosis.
Methods In total, 62 groin lymph nodes (LNs) of 46 limbs were divided into four groups based
on the findings of indocyanine green lymphography: n = 15 in normal, 15 in dermal backflow stage 0, 18 in stage I, and 14 in stage II
groups. The target LN and afferent lymphatic connecting it were preoperatively detected
using ultrasonography. Intraoperatively, 0.05 mL patent blue dye was slowly manually
injected from the afferent lymphatic; the lymphatic(s) subsequently stained was diagnosed
as the efferent lymphatic(s) emerging from the node. The success rates of efferent
lymphatic detection, sizes of LN, and diameter of efferent lymphatics were compared
among the groups.
Results Both LN size and diameter of efferent lymphatic were significantly larger in the
stage 0 and I groups than the other groups (p < 0.01). Efferent lymphatic could be stained in 13, 13, 18, and 9 LNs in the normal
and stage 0, I, and II groups, respectively. A significant difference was observed
between the stage I and II groups regarding the success rate of efferent lymphatic
detection (p = 0.04).
Conclusion Efferent lymphatics could be detected using patent blue dye in 85.5% of the cases.
The patients in early-stage lymphostasis might be the most appropriate candidates
for ELVA.
Keywords
lymphedema - efferent lymphatic - lymphaticovenular anastomosis
