Airborne, Needle Stenting, and Nip Stitch

The efficacy of lymphaticovenular anastomosis (LVA) procedure requires precise preoperative patient selection and surgical planning. In our experience with over 1000 LVAs, we found functional lymphatic channels to have an average caliber of 0.7 mm (ranging from 0.4 to 1.8 mm). The preoperative planning with ultrasound allows us to locate the recipient venule, which we consider favorable when there is the absence of blood backflow and those with a caliber of up to 2 mm. Three main drawbacks can be found during the anastomosis: (1) caliber mismatch between lymphatic channel and recipient venule; (2) difficult 12-0 thread manipulation due to the tendency of sticking related to the presence of lymph fluid from the wound; and (3) lymphatic wall edge tendency to collapse and invaginate. In this paper, the author describes and provides an intraoperative demonstration of our surgical tips (the needle stenting, the airborne suture, and the nip stitch techniques) to overcome the aforementioned drawbacks. This may aid microsurgeons in the execution of LVAs for the treatment of lymphedema.