皮弁を経由したリンパ管再生

抄録

In skin flap transplantation, the lymph vessels are not usually anastomosed but remain severed. Although studies have shown spontaneous regeneration of lymphatic channels from flap to regional lymph nodes via lymphoscintigraphy, the lymphatic drainage pathway changes that occur after flap transfer are unclear. Here, we observed lymphatic flow around flaps using indocyanine green ( ICG ) fluorescence lymphangiography in 12 patients. In all cases, the flaps were transplanted after resection of malignant tumors in the extremities. We injected ICG into the normal skin distal to the flap and then observed the lymphatic flow through the flaps. Normal lymphatic flow ( linear pattern ) in the flap was not observed; rather, in most cases, diffused dye patterns ( stardust or diffuse ) arising from extravascular fluorescence were observed. This finding indicates that an anatomically functional normal channel in the flap was not regenerated in these cases. We presume that flap layout, flap size, postoperative duration, radiation therapy, and scarring around the flap affect lymphangiogenesis through the flap. Since ICG fluorescence lymphangiography is limited, especially for visualizing the deep lymphatics, its combination use with other methods is needed to clarify the three-dimensional lymphatic pathways around the flap.