The Utility of the Airborne Technique for Lymphaticovenular Anastomosis

Abstract

Sir: Lymphaticovenular anastomosis has various merits. It is a minimally invasive operation that can be performed under local anesthesia.1 In addition, lymphaticovenular anastomosis provides favorable results, such as reduction of edema symptoms and prevention of cellulitis. Various procedures for lymphaticovenular anastomosis have been reported, such as the superior-edge-of-the-knee incision method2 and the diamond-shaped anastomosis method.3 However, the more anastomoses between veins and lymph ducts that are performed, the greater the effect of lymphedema treatment that is expected.4 The airborne technique was described by Chen et al. in 2004 as a suturing method that involves floating the stump of the thread at ligation.5 We report on the successful application and positive outcomes of the airborne technique for lymphaticovenular anastomosis. We performed lymphaticovenular anastomosis for secondary lymphedema using either the airborne technique or the conventional technique (20 cases each) and compared the operative time associated with each technique. Surgical procedures were conducted under local anesthesia in all cases. All procedures were performed by a single surgeon with more than 100 clinical cases worth of experience in microvascular anastomosis for free flap transfer and more than 100 clinical cases worth of experience in lymphaticovenular anastomosis. We compared the number of stitches and the type of thread that was used in individual anastomoses. The number of stitches in one lymphaticovenular anastomosis was six to eight. The size of the thread used during conventional lymphaticovenular anastomosis was 10-0 in four cases and 11-0 in 16 cases. The thread size used during lymphaticovenular anastomosis using the airborne technique was 10-0 in four cases and 11-0 in 16 cases. The average number of stitches required was 6.9 for the airborne technique and 6.3 for the conventional technique. The mean operative time required was 12.4 minutes (range, 11 to 15 minutes) for the airborne technique and 15.9 minutes (range, 14 to 18 minutes) for the conventional technique (Table 1).Table 1.: Comparison between Conventional Lymphaticovenular Anastomosis and the Airborne Technique for Lymphaticovenular AnastomosisThe airborne technique is an innovative suturing technique during microsurgery. The airborne technique involves floating the stump of the thread in air at the point of ligation, which prevents the thread from sticking peripherally. According to our results, the average operative time associated with the airborne technique was observed to be approximately three-fourths of the operative time associated with the conventional procedure. Generally, lymphaticovenular anastomosis often takes longer compared with normal microsurgical anastomosis because the lymphatics are clear and very thin. In addition, because the thread used is very thin in the lymphaticovenular anastomosis, it is hard to catch the free stump of the thread with forceps, thereby increasing the time required to ligate a thread after inserting the needle into the lymphatic duct and vein. In other words, we could omit unnecessary time when we anastomose without the involution and the catch of the surrounding tissue at the ligation of the thread. Finally, lymphaticovenular anastomosis can be performed even under local anesthesia and is a minimally invasive surgical method. Shortening the time necessary for a single anastomosis is necessary to perform multiple anastomoses within a safe operative period. Therefore, the airborne technique can be regarded as a useful method in lymphaticovenular anastomosis. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Satoshi Onoda, Ph.D.Kinoshita Masahito, M.D.Department of Plastic and Reconstructive SurgeryKagawa Rosai HospitalKagawa, Japan