A new lymph-duct cannulator.

Abstract

Lymphangiography has become an important diagnostic and therapeutic modality since its introduction by Kinmonth, Taylor and Harper in 1955. Locating a suitable lymph vessel and cannulating that vessel remain difficult, however, even for those with keen eyes and sure hands (DeRoo, 1966; Howland, 1972; Kuisk and Panning, 1967; Miller, 1967; Norman, 1971; Tong, 1969; Turner, 1966; Viamonte and Stevens, 1966). Insertion of the needle into the vessel is simplified by the lymphduct cannulator described here. The localization of the lymph vessel is a modification of the technique of Kinmonth et al. (1955). 0·5 ml. of a solution of Evans Blue dye mixed in a 1:1 ratio with 1 per cent lidocaine hydrochloride (Xylocaine) is injected intradermally and subcutaneously into each of the three web spaces between the 1st and 4th toes. After ten minutes the dyecarrying lymphatics are easily identified. A flat area on the dorsum of the foot is chosen for the skin incision to allow stable placement of the lymph-duct cannulator. A transverse incision is made, and the dermal layer is opened. The dye-filled lymphatic ducts are easily seen in the subcutaneous tissue. An appropriate lymph duct is isolated by careful blunt dissection with a haemostat. It is important to clean the duct thoroughly by meticulously removing all the surrounding tissue. This greatly facilitates cannulation of the vessel.