Work

Hand/Wrist Dye Injections Afford Improved Lymphatic Channel Selection for Immediate Lymphatic Reconstruction

Year: 2024

Type: article

Abstract: Background: Identification and selection of lymphatic channels to create a lymphovenous bypass (LVB) is critical in immediate lymphatic reconstruction (ILR). Visualization of channels is dependent on dye injection into the arm. There remains uncertainty over which channel to select for LVB when multiple channels are visualized. We compared features of channels between ILR patients who received fluorescein (FITC) dye injections in the hand/wrist or medial upper-arm. Methods: A retrospective review of ILR patients from September 2016 to April 2023 was performed. Intraoperative measurements were collected, including FITC injection-site, number of channels visualized, channel distances from the axillary vein (cm), and channel diameters (mm). We compared injection-site groups by the proportion of patients per number of channels visualized. Injection-site groups were also compared by channel distances from the axillary vein and channel diameters. A sub-analysis comparing injection-site groups by channel distances from the axillary vein and channel diameters for each patient’s largest-diameter channel was also performed. Results: A total of 327 patients were included, with 177 patients receiving hand/wrist injections and 150 patients receiving medial upper-arm injections. The proportions of patients by number of channels differed significantly, with fewer channels visualized from hand/wrist injections (p=.002). A median of two channels were visualized from hand/wrist injections while a median of three channels were visualized from medial upper-arm injections (p<.001). Channels were closer to the axillary vein when visualized by hand/wrist injections (median= 2.3 cm) compared to medial upper-arm injections (median= 2.7 cm) (p<.001). There was no significant difference in channel diameters between injection-site groups (median= 0.45 mm in both groups) (p= 0.066). Patients’ largest-diameter channels were closer to the axillary vein when visualized by hand/wrist injections (median= 2.1 cm) compared to medial upper-arm injections (median= 2.8 cm) (p<.001). There was no significant difference in diameters of the largest-diameter channels between injection-site groups (median= 0.6 mm in both groups) (p = 0.888). Conclusion: Hand/wrist dye injections optimize creation of a LVB during ILR by visualizing fewer lymphatic channels that are closer to the axillary vein. Our findings corroborate prior anatomic studies which report that the main lymphatic collecting channels of the arm course closely along the axillary vein. We propose that hand/wrist dye injections are more likely to identify the main lymphatic channels of the arm. Further research will clarify if using channels visualized by hand/wrist dye injections to create the LVB translates to improved ILR outcomes.

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0001006208.75596.e0

Authors: Fanning James E., Rosie Friedman, Mohamed E. Ismail Aly, Dhruv Singhal

Institutions: Beth Israel Deaconess Medical Center, Harvard University

Language: English

Topic: Lymphatic System and Diseases

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,195