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Fluorescein Isothiocyanate: A Modification for Reverse Lymphatic Mapping in Lymph Node Transplantation
Dhruv Singhal, MD, Lisa Spiguel, MD, Derly Munoz, PT, Christiana Shaw, MD, Walter Drane, MD.
University of Florida School of Medicine, Gainesville, FL, USA.

PURPOSE: Reverse lymphatic mapping (RLM) reduces the risk of donor site lymphedema during lymph node transplantation (LNT) but is limited as mapping and dissection can not be performed simultaneously. We hypothesized that RLM with fluorescein isothiocyanate (FITC) would provide this advantage. Our goal was to demonstrate the safety and efficacy of FITC for RLM.
METHODS: We reviewed a prospectively collected database of patients undergoing LNT utilizing our modified RLM technique from March to September 2015. FITC was injected into the donor extremity and flap dissection was performed under a Yellow 560 filter to simultaneously visualize and avoid critical donor lymphatic channels.
RESULTS: Twelve patients underwent LNT utilizing our modified RLM technique from March to September 2015. Average patient age was 59 years with a mean BMI of 35. Eleven superficial circumflex iliac artery flaps and 1 transverse cervical flap were harvested. In 4 cases, FITC lymphatic imaging improved precision of the dissection plane. No intra-operative adverse events were noted. Donor site complications included 3 seromas and 1 cellulitis. Post-operative donor extremity lymphatic evaluations were normal in all patients at an average of 6.7 months, except for one patient diagnosed with an ipsilateral DVT at 3 months.
CONCLUSION: Our modified RLM technique with FITC is a safe modification adding precision to RLM. FITC maintains life-like color in non-fluoresced tissues allowing for simultaneous dissection and lymphatic mapping.


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