Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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A Non-suture Cuff Technique For Lymph-vein Anastomosis In a Rat Model
Dedi Tong, MD1, Shan Zhu, MD1, Yong Huang, Phd2, Lehao Wu, MD1, Zuhaib Ibrahim, MD1, Qi Mao, MD1, Jin Li, MD1, Damon S. Cooney, MD1, W.P. Andrew Lee, MD1, Gerald Brandacher, MD1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, Baltimore, MD, USA.

A Non-suture Cuff Technique for Lymph-vein Anastomosis In a Rat Model
Dedi Tong1, 3, Shan Zhu2, 3, Yong Huang4, Lehao Wu3, Zuhaib Ibrahim3, Qi Mao3, Jin Li3, Damon S. Cooney3, W.P. Andrew Lee3, Gerald Brandacher3*
1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
2 Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, PUMC, CAMS, Beijing, China
3 Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
4 Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD
PURPOSE: Lymph-vein anastomosis has been an effective way to treat lymphedema. However, the extremely thin and fragile wall of both the lymphatic vessels and vein impose great technical microsurgical challenges. In this pilot project we explored a novel cuff-based non-suture technique for lymph-vein anastomosis in a rat model, aiming to improve the success rate and reduce operation time.
METHOD: A total of 15 Lewis rats (age: 6-8 weeks, body weight: 252.8±3.78g) underwent lymph-vein anastomosis. The left cervical branch of the lymphatic duct that commence into the thoracic duct and the facial vein were freed and dissected. Lymph-vein anastomosis was performed in an end-to-end fashion using a polyimide tube (0.368361mm as inner diameter, 0.41148mm as outer diameter), which was prepared into a wedge-like cuff. After the cuff was mounted on the lymph duct, the duct was then inverted and held in place with a circular tie. Next the facial vein was pulled over the lymph stent and anastomosis was completed with a second nylon tie over the cuff. All anastomoses were evaluated by histology on post-op day 7.
RESULTS: Total operating time averaged about 2.3±0.28 hours. Lymph-vein anastomosis could be completed within 16.8±4.3 minutes. All 15 procedures in this series were successful. Histology on post-operative day 7 showed patent anastomosis in all cases with both vein and lymph endothelia smooth and intact, no evidence of thrombus formation.
CONCLUSION: This novel non-suture cuff based technique is a safe, efficient and reliable method for lymph-vein anastomosis, which might offer a promising approach that could be utilized in clinical lymphedema surgery.


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