Identifying Somatic Lymph Nodes for VLNT Using Technetium-99m Sulfur Colloid

Area of Science:

• Microsurgery
• Surgical Oncology
• Lymphedema Management

Background:

• Chronic lymphedema, often resulting from breast cancer treatment or lower extremity issues, requires effective management strategies.
• Vascularized lymph node transplant (VLNT) offers a safe and effective treatment for lymphedema, with benefits becoming fully apparent two years post-surgery.
• A key challenge in VLNT is ensuring adequate lymph node inclusion in the flap, necessitating reliable pre-harvest identification methods.

Purpose of the Study:

• To evaluate the use of radiotracer (Technetium-99m sulfur colloid) and indocyanine green (ICG) for improved lymph node identification during Vascularized Lymph Node Transplant (VLNT).
• To enhance the reliability and success rate of VLNT procedures by ensuring accurate lymph node harvesting and transfer.

Main Methods:

• Utilizing Technetium-99m sulfur colloid, similar to sentinel lymph node biopsy techniques, to identify lymph nodes prior to surgical harvest.
• Employing methylene blue dye and indocyanine green (ICG) in conjunction with radiotracer to confirm lymph node presence before and after microvascular transfer.
• Conducting a pilot study involving eight cases to assess the efficacy of the combined identification methods.

Main Results:

• The pilot study successfully identified lymph nodes in all eight transferred tissue samples.
• The use of radiotracer and ICG demonstrated high reliability in localizing lymph nodes for harvest and transfer.
• This method provides confirmation of lymph node presence throughout the VLNT procedure, from identification to post-transfer.

Conclusions:

• Radiotracer and ICG are effective adjuncts for identifying lymph nodes in VLNT, improving procedural reliability.
• The enhanced identification method ensures adequate lymph node quantity and vascularity, crucial for successful lymphedema treatment.
• This technique offers a more dependable approach to VLNT, potentially improving outcomes for patients with chronic lymphedema.