LAUSR

Background The aim of our study was to evaluate a new propeller vascularized lymphatic tissue flap (pLNT) combined with aligned nanofibrillar collagen scaffolds (CS) (BioBridge®) in reducing lymphedema in the rat lymphedema model. Methods Unilateral left hind limb lymphedema was created in 15 female Sprague-Dawley rats following inguinal and popliteal lymph nodes (LN) resection and radiation. An inguinal pLNT was elevated from the contralateral groin and transferred through a skin tunnel to the affected groin. Four collagen threads were attached to the flap and inserted in the hind limb at the subcutaneous level in a fan shape. The three study groups consisted of Group A (control), Group B (pLNT), and Group C (pLNT + CS). Volumetric analysis of both hind limbs was performed using micro-CT imaging before the surgery (at initial time point) and then at 1 and 4 months postoperatively, and the relative volume difference (excess volume) was measured for each animal. Lymphatic drainage was assessed by ICG fluoroscopy for number and morphology of new collectors and the time required for ICG to move from injection point to the midline. Results Four months after the surgery an increased relative volume difference remained in group A (5,321% ± 4,74), while there was a significant relative volume reduction in group B (-13,395% ± 8,545) and an even greater reduction in group C (-14,560% ± 5,042). ICG fluoroscopy proved the functional restoration of lymphatic vessels through the CS and the viability of pLNT in both B and C groups. Conclusion The pedicle lymphatic tissue flap combined with collagen scaffolds is an effective procedure for the treatment of lymphedema in rats. It can be easily translated into treatment of humans' lower and upper limb lymphedema; further clinical studies are required prior to recommend the above method.