Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis

Background: Lymph system plays important roles in maintaining fluid balances, immune system, and lipid metabolism. After tissue replantation or transfer, some cases suffer from long-lasting edema or lymphedema due to interruption of main lymph flows, but its mechanism is yet to be clarified. Methods: Medical charts of 38 patients who underwent ICG lymphography after tissue replantation or free flap transfer were reviewed to obtain data of clinical demographics, intraoperative findings, and postoperative ICG lymphography findings. Postoperative lymph flow restoration (LFR) based on ICG lymphography findings were evaluated according to intraoperative findings including raw-surface in lymph axiality (RLA) and compatible lymph axiality (CLA). Results: LFR was observed in 24 cases (63%). There were significant differences of positive for LFR in sex (male 78% vs. female 40%, P = 0.017), cause of defect (trauma 83% vs. others 33%, P = 0.002), type of operation (replantation 94% vs. free flap 41%, P = 0.001), and CLA (positive 96% vs. negative 0%, P

https://ift.tt/2lLoOgr