This presentation describes immediate lymphatic reconstruction. This elderly female has a positive node in the right groin several years after initial white excision, and she is now planned for an ilioinguinal node dissection. A dual injection technique is used, with 1 cc of patent blue dye and 1 cc of ICG dye near the first web space. The injection site is quickly covered to prevent contamination of the field. The SPI-PHY is used to intermittently image the major channels up the leg and into the groin. The resecting surgeon carries out the lymph node dissection from cephalad to caudal, leaving the leg lymphatics intact until the end. Any available veins are preserved. Here the packet of nodes remains attached distally for lymphatic dissection and tagging. The packet is laid back down and the lymphatics are dissected toward the lymph nodes. Three lymphatics have been tagged with Vicryl and Eclif and are readied for anastomosis. Suitable veins and lymphatics are chosen and placed in clamps, and the anastomoses are carried out. Here a single lymphatic is sutured end-to-side into a vein. The clamps are then released. Here are two LVAs shown in a different patient. Usually 1-4 LVAs are completed. Flow can be confirmed through the anastomosis using a strip test, watching the ICG flow from the lymphatic into the vein. At one year, our patient is disease-free, has no measurable lymphedema, and excellent limb qual scores. The blue stain on her foot continues to fade.

lymphatic reconstruction

ilioinguinal node dissection

lymphatic-venous anastomoses

blue dye

ICG dye