Patent blue-enhanced lymphaticovenular anastomosis.

Area of Science:

• Vascular Surgery
• Lymphedema Management
• Supermicrosurgery

Background:

• Lymphoedema supermicrosurgery is challenging due to the small, translucent nature of lymphatic vessels (<1 mm).
• Patent blue is an organic colorant that enhances lymphatic network visualization.
• Evaluating patent blue's morbidity and efficacy is crucial for lymphaticovenular anastomosis.

Purpose of the Study:

• To assess the safety and effectiveness of patent blue in enhancing lymphatic visualization for lymphaticovenular anastomosis.
• To evaluate the morbidity associated with patent blue injection.
• To determine the impact of patent blue-enhanced lymphaticovenular anastomosis on limb volume reduction in lymphoedema patients.

Main Methods:

• A cohort of 20 patients with chronic upper limb lymphoedema underwent lymphaticovenular anastomosis.
• Patent blue (1.3 ml average) was injected subdermally to enhance lymphatic vessels.
• Surgical outcomes were assessed by quantifying enhanced lymphatic vessels and measuring limb volume changes.

Main Results:

• An average of 2.1 lymphatic vessels (0.3-0.8 mm caliber) were visualized per site with good to excellent enhancement in 92% of cases.
• No allergic or infectious complications occurred; mean operative time was 2.3 hours.
• Significant limb volume reduction was observed: 13.2% circumferentially, 24.1% in cross-sectional area, and 22.8% in volume (p<0.001).

Conclusions:

• Patent blue-enhanced lymphaticovenular anastomosis is a safe and effective treatment for secondary lymphoedema.
• The technique is easy to use, cost-effective, and demonstrates high efficacy in reducing limb swelling.
• Prioritizing this method for lymphaticovenular anastomosis is recommended due to its favorable outcomes.