Now, we cannot always find adequate size lymphatic of a recipient vein with a minimal backflow. Sometimes the vein that we find could be large or have significant backflow, then we'll do end-to-side osmosis. In this particular lymphatic, there's a lot of isosome blue, so it makes it very easy to see them even without the help of fluorescent. So here is the lymphatic vessel, which is about 0.45 millimeter. The main is a little bit larger than 1 millimeter, maybe 1.5 millimeter or so. We check to make sure that we are bypassing in the right direction, and then look for the lumen there. This is a nice lumen, and you can see there's a lymphatic fluid coming out. In this particular case, this is probably about 11 ohm amide suture we used. We have to be ensured that the lymphatic lumen is within the venous lumen so that the flow will easily go from lymphatic side into the vein. After the asthmosis, first the distal plant is removed. And then the proximal plant is removed. Make sure there's no venous leak. And then on the flaccidome, you can see, check for the patency by seeing the ICGN go into the vein, you can see flowing in and out. There's another view of the ICGN going into the vein, very fast. Here again, some examples of a patency test with the ICGN going into the vein after N2 cytosmosis. There's some still photos with the isosulfone blue. This is an example of N2 asthmosis.

end-to-side anastomosis

lymphatic surgery

isosulfone blue

ICG dye

patency tests