Abstract
Background Extremity lymphedema is a dreaded complication of ilioinguinal or axillary lymphadenectomy.
In conventional lymph node dissection, no effort is performed to maintain or reestablish
extremity lymphatic circulation. We hypothesized that immediate lymphatic reconstruction
(ILR) could be a reproducible procedure to maintain functional lymphatic flow after
ilioinguinal and axillary lymphadenectomy in patients with malignant melanoma. This
is the first report describing prophylactic ILR in patients with melanoma who underwent
complete lymph node dissection for gross nodal disease.
Patients and Methods We report a case series of 22 malignant melanoma patients who had axillary or ilioinguinal
lymph node dissection for bulky locoregional invasion with immediate lymphatic reconstruction.
A novel method to identify and select lymphatics with high flow using fluorescent
lymphangiogram with indocyanine green dye gradient software is described. Surgical
details, common difficulties, as well as indications are discussed. Instructional
videos are also provided.
Results Our technique is reproducible, since we have successfully completed immediate lymphatic
reconstruction in 22 cases consecutively. Intradermal indocyanine green injections
allowed for visualization of 1 to 3 transected lymphatics after lymphadenectomy. An
average of 1.8 lymphaticovenous bypass (range 1–3) was performed per patient.
Conclusion Reestablishment of lymphatic circulation after ilioinguinal or axillary lymphadenectomy
in patients with melanoma characterizes a novel method that may reduce the problem
of upper and lower extremity iatrogenic lymphedema. This is particularly important
given the emergence of new adjuvant treatment modalities that considerably improve
patients' survival after lymphadenectomy.
Keywords
lymphedema - lymphaticovenous bypass - lymphadenectomy - melanoma - lymph node dissection
- lymphaticovenular anastomosis
