Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Vascularized Axillary Lymph Node Transfer: A Novel Model in the Rat
Grzegorz Kwiecien, MD, Safak Uygur, MD, Jason Korn, MD, Bahar Bassiri Gharb, MD, PhD, Maria Madajka, PhD, Risal Djohan, MD, James E. Zins, MD, Graham S. Schwarz, MD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE: Vascularized lymph node transfer (VLNT) is a promising technique for the surgical treatment of lymphedema. To date, few experimental animal models for VLNT have been described and the viability of lymph nodes after the transfer tested. We aimed to evaluate the feasibility of axillary VLNT in the rat.
METHODS: Lymph node containing flaps were harvested from the axillary region in ten Lewis rats based on the axillary vessels (Figure 1 and 2). Flaps were transferred to the ipsilateral groin and end-to-side microanastomosis was performed to the femoral vessels using 10-0 sutures. Indocyanine green (ICG) angiography was used to confirm flap perfusion. On postoperative day 7, flaps were elevated to assess their structure and vessel patency. H&E staining was used to confirm the presence and viability of lymph nodes.
RESULTS: All animals tolerated the procedure well. Immediate post-procedure ICG angiography confirmed flap perfusion (Figure 2). No signs of ischemia or necrosis were observed in donor extremities. At postoperative day 7, all flaps remained viable with patent vascular pedicles. Macroscopically and histologically, 3.6±0.5 viable lymph nodes were identified in each flap.
CONCLUSIONS: This study showed that the transfer of axillary lymph nodes based on the axillary vessels is feasible. The flap can be used without the need for donor animals and it contains a consistent number of lymph nodes. This reliable VLNT can be further utilized in studies involving lymphedema, transplantation and induction of immunologic tolerance.

Figure 1. Neurovascular anatomic features of the rat axilla: 1, axillary artery; 2, lateral thoracic artery; 3, lateral thoracic vein; 4, axillary vein; 5, brachial artery; 6, brachial vein; 7, medial anterior thoracic nerve; 8, branch to cutaneous maximus; 9, median nerve; 10, ulnar nerve; asterisk, axillary lymph node flap

Figure 2. Elevated axillary flap with visible lymph nodes. Inset: Indocyanine green angiography showing well perfused flap successfully transferred to the ipsilateral groin.

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