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Plastic Surgery Research Council

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Dermal Lymphatic Backflow Pattern in Rat Hind Limb Chronic Lymphatic Dysfunction Model
Vahe Fahradyan, MD, Edoardo Dalla Pozza, MD, Grzegorz Kwiecien, MD, Cagri Cakmakoglu, MD, Maria Madajka, PhD, Bahar Bassiri Gharb, MD, PhD, James Zins, MD, Graham Schwarz, MD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE: The purpose of our study was to create a rat chronic lymphedema model that could be used for the evaluation of vascularized lymph node transfer (VLNT) effects on the lymphedematous limb.
METHODS: Sprague Dawley rats underwent surgical resection of lymphatic structures in the right hind-limb followed by local groin irradiation (n=7). The inguinal and popliteal lymph nodes and deep lymphatics were identified and resected. An unfractionated dose of 20Gy was delivered to the rat limb with an effective field size of 3.5 x 2.5 cm. The skin edges were sutured to underlying muscles creating a 5-10mm gap to prevent spontaneous lymphatic regeneration. The animals were followed-up one year.
RESULTS: All animals developed clinical lymphedema in one-month post-op, however, they spontaneously recovered following three-months post-op. ICG lymphangiography revealed a distinct difference in a lymphatic drainage pattern between two sides at one-year post-op. A diffuse superficial reticular pattern (Figure 1) reached the border of the surgical scar on the experimental side, whereas the control side had a normal linear pattern (Figure 2). The wave pattern of the lymph flow generated by the physiologic contraction of the lymph vessels was present on the control side but was absent on the experimental side.
CONCLUSION: Considering the lack of good alternative models of secondary lymphedema, this method could be effectively used to investigate the potential benefits of VLNT.

Figure 1. Reticular dermal flow pattern (experimental side).

Figure 2. Normal linnear pattern (control side).

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